Individual provider Active NPI

Gretta Herbert, OFFICE ADMINISTRATOR

  • Specialist
  • Fairfax, VA
National Provider Identifier
1780078030
Registry record updated Mar 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
541148368 Issued in VA
Practice address
3620 Joseph Siewick Dr
Suite 307
Fairfax, VA 22033-1756
Phone
(703) 281-1023
Fax
(703) 620-2331
NPI assigned
Mar 25, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 541148368 VA Primary

Addresses

Primary practice location

3620 Joseph Siewick Dr
Suite 307
Fairfax, VA 22033-1756

Mailing address

3620 Joseph Siewick Dr
Suite 307
Fairfax, VA 22033-1756
Phone (703) 281-1023

Other identifiers 1

IdentifierTypeStateIssuer
1063443802OtherVA1063443802

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
541148368VAMDSpecialist

NPI Registry JSON

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

{
    "created_epoch": "1427241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427241600000",
    "number": "1780078030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3620 JOSEPH SIEWICK DR",
            "address_2": "SUITE 307",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331756",
            "telephone_number": "703-281-1023",
            "fax_number": "703-620-2331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3620 JOSEPH SIEWICK DR",
            "address_2": "SUITE 307",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331756",
            "telephone_number": "703-281-1023",
            "fax_number": "703-620-2331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERBERT",
        "first_name": "GRETTA",
        "credential": "OFFICE ADMINISTRATOR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-25",
        "last_updated": "2015-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "VA",
            "license": "541148368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1063443802",
            "identifier": "1063443802",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2015; 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.