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General NPI Number Information
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NPI Number | 1467475822
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Entity Type | Organization
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Legal Business Name | GENERAL AND LAPAROSCOPIC SURGICAL ASSOCIATES
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 4660 KENMORE AVE SUITE 419
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City | ALEXANDRIA
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State | VA
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Zip | 22304-1313
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Country | US
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Telephone | 703-823-4066
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Fax | 703-823-4067
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Provider Business Mailing Address
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Address Line | 4660 KENMORE AVE SUITE 419
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City | ALEXANDRIA
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State | VA
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Zip | 22304
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Country | US
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Telephone | 703-823-4066
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Fax | 703-823-4067
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEFANO FRANCO AGOLINI
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Credential | MD
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Telephone | 703-823-4066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0101057385
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License Number State | VA
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