NPIMap

Individual provider Active NPI

Wali Gauvin, MD

  • Pediatric Cardiology Physician
  • Woodbridge, VA
National Provider Identifier
1467485383
Registry record updated Apr 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
0101242065 Issued in VA
Practice address
14130 Noblewood PLZ
Suite 306
Woodbridge, VA 22193-1464
Phone
(800) 784-8590
Fax
(877) 755-3396
NPI assigned
Jul 7, 2006
Last updated
Apr 1, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X D0067292 MD
Specialist 174400000X 0101242065 VA
Pediatrics Physician 208000000X 0101242065 VA
Pediatric Cardiology Physician 2080P0202X D0067292 MD
Pediatric Cardiology Physician 2080P0202X 0101242065 VA Primary

Addresses

Primary practice location

14130 Noblewood PLZ
Suite 306
Woodbridge, VA 22193-1464

Mailing address

14130 Noblewood PLZ
Suite 306
Woodbridge, VA 22193-1464
Phone (800) 784-8590

Other identifiers 2

IdentifierTypeStateIssuer
017057700MedicaidMD
015161604MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0067292MDMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Frederick Health Hospital Inc Past Accepting new patients
PM Kids Pediatrics Past Accepting new patients
Children's Heart Institute Specialist Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648771200000",
    "number": "1467485383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14130 NOBLEWOOD PLZ",
            "address_2": "SUITE 306",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221931464",
            "telephone_number": "800-784-8590",
            "fax_number": "877-755-3396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14130 NOBLEWOOD PLZ",
            "address_2": "SUITE 306",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221931464",
            "telephone_number": "800-784-8590",
            "fax_number": "877-755-3396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAUVIN",
        "first_name": "WALI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2022-04-01",
        "certification_date": "2022-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MD",
            "license": "D0067292",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "VA",
            "license": "0101242065",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101242065",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "MD",
            "license": "D0067292",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "VA",
            "license": "0101242065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017057700",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015161604",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.