Healthcare Provider Details

I. General information

NPI: 1255018412
Provider Name (Legal Business Name): THOMAS MINIK-MASCITTI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3300
US

IV. Provider business mailing address

2501 PARKERS LN
ALEXANDRIA VA
22306-3209
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-3582
  • Fax:
Mailing address:
  • Phone: 630-432-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0102209417
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: