Healthcare Provider Details

I. General information

NPI: 1356315840
Provider Name (Legal Business Name): LAURA M GESICKI-WOOD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8134 OLD KEENE MILL RD 301
SPRINGFIELD VA
22152-1800
US

IV. Provider business mailing address

8134 OLD KEENE MILL RD 301
SPRINGFIELD VA
22152-1800
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-1913
  • Fax: 703-569-6035
Mailing address:
  • Phone: 703-569-1913
  • Fax: 703-569-6035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number0101237445
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: