Provider Demographics
NPI:1871526954
Name:GALL, ADAM FREDERICK JR (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:FREDERICK
Last Name:GALL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 AMHERST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3340
Mailing Address - Country:US
Mailing Address - Phone:540-542-0054
Mailing Address - Fax:540-542-0029
Practice Address - Street 1:1104 AMHERST ST STE 100
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3340
Practice Address - Country:US
Practice Address - Phone:540-542-0054
Practice Address - Fax:540-542-0029
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237397174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010210411Medicaid
VA010210411Medicaid
VAD-98071Medicare UPIN