Healthcare Provider Details

I. General information

NPI: 1215342621
Provider Name (Legal Business Name): GIORGOS HADJIVASSILIOU MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6677 RICHMOND HWY
ALEXANDRIA VA
22306-6647
US

IV. Provider business mailing address

6677 RICHMOND HWY
ALEXANDRIA VA
22306-6647
US

V. Phone/Fax

Practice location:
  • Phone: 703-535-5568
  • Fax:
Mailing address:
  • Phone: 703-535-5568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101267728
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number36128
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101267728
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: