Healthcare Provider Details

I. General information

NPI: 1235363789
Provider Name (Legal Business Name): GREGORY THOMAS TRIFILO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/20/2024
Certification Date: 05/03/2024
Deactivation Date: 05/03/2024
Reactivation Date: 05/20/2024

III. Provider practice location address

4301 JONES BRIDGE RD
BETHESDA MD
20814-4712
US

IV. Provider business mailing address

4301 JONES BRIDGE RD
BETHESDA MD
20814-4712
US

V. Phone/Fax

Practice location:
  • Phone: 800-515-5257
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101249105
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberDR.0064622
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: