Healthcare Provider Details

I. General information

NPI: 1922343060
Provider Name (Legal Business Name): CHARLES MICHAEL CIFIZZARI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11711 HARVESTDALE DR
FREDERICKSBURG VA
22407-7414
US

IV. Provider business mailing address

11711 HARVESTDALE DR
FREDERICKSBURG VA
22407-7414
US

V. Phone/Fax

Practice location:
  • Phone: 540-445-1122
  • Fax:
Mailing address:
  • Phone: 540-445-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: