Healthcare Provider Details

I. General information

NPI: 1629066816
Provider Name (Legal Business Name): GERARD JULIO RANIERI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12656-B LAKE RIDGE DRIVE
WOODBRIDGE VA
22192-7504
US

IV. Provider business mailing address

12656 LAKE RIDGE DR STE B
WOODBRIDGE VA
22192-7504
US

V. Phone/Fax

Practice location:
  • Phone: 703-491-2603
  • Fax: 703-491-0752
Mailing address:
  • Phone: 703-491-2603
  • Fax: 703-491-0752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103000771
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36002143
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: