Healthcare Provider Details

I. General information

NPI: 1124860424
Provider Name (Legal Business Name): CHRISTINA ANN GEREW PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 MARK CENTER DR STE 150
ALEXANDRIA VA
22311-1843
US

IV. Provider business mailing address

4825 MARK CENTER DR STE 150
ALEXANDRIA VA
22311-1843
US

V. Phone/Fax

Practice location:
  • Phone: 703-751-8111
  • Fax: 703-751-1105
Mailing address:
  • Phone: 703-751-8111
  • Fax: 703-751-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011527
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110011527
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: