Healthcare Provider Details

I. General information

NPI: 1831079268
Provider Name (Legal Business Name): MARCELO A. DAVILA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SEMINARY RD
ALEXANDRIA VA
22304-1535
US

IV. Provider business mailing address

4320 SEMINARY RD
ALEXANDRIA VA
22304-1535
US

V. Phone/Fax

Practice location:
  • Phone: 703-504-3510
  • Fax:
Mailing address:
  • Phone: 703-504-3510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: