Healthcare Provider Details

I. General information

NPI: 1679688394
Provider Name (Legal Business Name): LUCILLE LYNN GERONA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3259 CATLIN AVE
QUANTICO VA
22134-5109
US

IV. Provider business mailing address

3259 CATLIN AVE STE 100
QUANTICO VA
22134-5109
US

V. Phone/Fax

Practice location:
  • Phone: 703-784-1627
  • Fax: 703-784-1987
Mailing address:
  • Phone: 703-784-1627
  • Fax: 703-784-1987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101242021
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: