Provider Demographics
NPI:1861747099
Name:GAN, ORON
Entity type:Individual
Prefix:
First Name:ORON
Middle Name:
Last Name:GAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 NEW YORK AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3320
Mailing Address - Country:US
Mailing Address - Phone:202-698-2431
Mailing Address - Fax:202-698-2466
Practice Address - Street 1:64 NEW YORK AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3320
Practice Address - Country:US
Practice Address - Phone:202-698-2431
Practice Address - Fax:202-698-2466
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000687103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist