Healthcare Provider Details

I. General information

NPI: 1255328423
Provider Name (Legal Business Name): JEFFREY L GRAZIANO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE STE 608
ALEXANDRIA VA
22304-1306
US

IV. Provider business mailing address

224D CORNWALL ST NW STE 403
LEESBURG VA
20176-2704
US

V. Phone/Fax

Practice location:
  • Phone: 703-379-0700
  • Fax:
Mailing address:
  • Phone: 703-737-6010
  • Fax: 703-443-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0103300846
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: