Healthcare Provider Details

I. General information

NPI: 1447205513
Provider Name (Legal Business Name): ROGER VICTOR GISOLFI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 PARKERS LN
ALEXANDRIA VA
22306-3209
US

IV. Provider business mailing address

P O BOX 829
ALEXANDRIA VA
22306
US

V. Phone/Fax

Practice location:
  • Phone: 703-664-7189
  • Fax: 410-793-0809
Mailing address:
  • Phone: 703-664-7189
  • Fax: 410-793-0809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number267220
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: