Healthcare Provider Details

I. General information

NPI: 1255457891
Provider Name (Legal Business Name): SEBASTAIN JAMES DISPENZA JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SEMINARY RD INOVA ALEXANDRIA HOSPITAL
ALEXANDRIA VA
22304
US

IV. Provider business mailing address

4320 SEMINARY RD INOVA ALEXANDRIA HOSPITAL
ALEXANDRIA VA
22304
US

V. Phone/Fax

Practice location:
  • Phone: 703-504-3314
  • Fax:
Mailing address:
  • Phone: 703-504-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101027600
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: