Healthcare Provider Details

I. General information

NPI: 1558485474
Provider Name (Legal Business Name): TONY TSITOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 LITTLE RIVER TPKE
ANNANDALE VA
22003-2923
US

IV. Provider business mailing address

7501 LITTLE RIVER TPKE
ANNANDALE VA
22003-2923
US

V. Phone/Fax

Practice location:
  • Phone: 703-941-5555
  • Fax:
Mailing address:
  • Phone: 703-941-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number0101018078
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: