Healthcare Provider Details

I. General information

NPI: 1649714155
Provider Name (Legal Business Name): ABOUT CARE GYN ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 JOSEPH SIEWICK DR SUITE 309
FAIRFAX VA
22033-1710
US

IV. Provider business mailing address

PO BOX 220925
CHANTILLY VA
20153-0925
US

V. Phone/Fax

Practice location:
  • Phone: 703-859-5225
  • Fax: 844-898-2182
Mailing address:
  • Phone: 703-859-5225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0101053044
License Number StateVA

VIII. Authorized Official

Name: DR. LILLIAN DECOSIMO
Title or Position: PHYSICIAN , SOLE MEMBER OWNER
Credential: M.D.
Phone: 703-859-5225