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General NPI Number Information
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NPI Number | 1316932809
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Entity Type | Individual
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Provider Name | JOHN JAMES WIERZBICKI D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 10/25/2017
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Provider Practice Location Address
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Address Line | 3401 COMMISSION CT STE 201
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City | WOODBRIDGE
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State | VA
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Zip | 22192-1771
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Country | US
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Telephone | 703-490-6265
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Fax | 703-490-6713
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Provider Business Mailing Address
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Address Line | 3401 COMMISSION CT
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City | WOODBRIDGE
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State | VA
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Zip | 22192-1771
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Country | US
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Telephone | 703-490-6265
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Fax | 703-490-6713
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102201607
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License Number State | VA
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