Healthcare Provider Details

I. General information

NPI: 1588466049
Provider Name (Legal Business Name): CORY BLAKE PISARRA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 WOOD ROAD BUILDING 1, 19TH FLOOR, ROOM 19123
BETHESDA MD
20889-5628
US

IV. Provider business mailing address

8955 WOOD ROAD BUILDING 1, 19TH FLOOR, ROOM 19123
BETHESDA MD
20889-5628
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-8373
  • Fax:
Mailing address:
  • Phone: 301-319-8373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102210307
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: