Healthcare Provider Details

I. General information

NPI: 1245358803
Provider Name (Legal Business Name): GIOVANNA MORENA M.D, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20749 RAINSBORO DR
ASHBURN VA
20147-2835
US

IV. Provider business mailing address

1707 OSAGE ST SUITE 404
ALEXANDRIA VA
22302-2607
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-1980
  • Fax: 703-723-1994
Mailing address:
  • Phone: 703-379-7215
  • Fax: 703-824-8212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberD41463
License Number StateMD

VIII. Authorized Official

Name: DR. GIOVANNA MORENA
Title or Position: PROPRIETOR
Credential: M.D.
Phone: 703-379-7215