NPIMap

Individual provider Active NPI

Gordon L Head, MD

  • Diagnostic Radiology Physician
  • Fairfax, VA
National Provider Identifier
1912925926
Registry record updated Jan 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
0101030851 Issued in VA
Practice address
2722 Merrilee Dr
Suite 230
Fairfax, VA 22031-4400
Phone
(703) 698-4483
Fax
(703) 573-0880
NPI assigned
Jul 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2008

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X 0101030851 VA
Neuroradiology Physician 2085N0700X 0101030851 VA
Nuclear Radiology Physician 2085N0904X 0101030851 VA
Pediatric Radiology Physician 2085P0229X 0101030851 VA
Diagnostic Radiology Physician 2085R0202X 0101030851 VA Primary
Vascular & Interventional Radiology Physician 2085R0204X 0101030851 VA
Diagnostic Ultrasound Physician 2085U0001X 0101030851 VA

Addresses

Primary practice location

2722 Merrilee Dr
Suite 230
Fairfax, VA 22031-4400

Mailing address

PO Box 3650
Fairfax, VA 22038-3650
Phone (703) 698-4483

Other identifiers 1

IdentifierTypeStateIssuer
0012OtherVACAREFIRST

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
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101030851VAMDNeuroradiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairfax Radiological Consultants Pediatric Radiology Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200268800000",
    "number": "1912925926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3650",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220383650",
            "telephone_number": "703-698-4483",
            "fax_number": "703-573-0880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2722 MERRILEE DR",
            "address_2": "SUITE 230",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314400",
            "telephone_number": "703-698-4483",
            "fax_number": "703-573-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEAD",
        "first_name": "GORDON",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2008-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "VA",
            "license": "0101030851",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "VA",
            "license": "0101030851",
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "VA",
            "license": "0101030851",
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "",
            "desc": "Radiology, Pediatric Radiology",
            "state": "VA",
            "license": "0101030851",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101030851",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "VA",
            "license": "0101030851",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "VA",
            "license": "0101030851",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "0012",
            "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 Jan 14, 2008; 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.