Healthcare Provider Details

I. General information

NPI: 1043465974
Provider Name (Legal Business Name): AUSTIN LEIGH GIUNTA CHURCHILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUTIN GIUNTA M.D.

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W BROAD ST STE 1B
FALLS CHURCH VA
22046-3206
US

IV. Provider business mailing address

502 W BROAD ST STE 1B
FALLS CHURCH VA
22046-3206
US

V. Phone/Fax

Practice location:
  • Phone: 703-894-2224
  • Fax: 315-800-5196
Mailing address:
  • Phone: 703-894-2224
  • Fax: 315-800-5196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101244561
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number0101244561
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: