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General NPI Number Information
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NPI Number | 1578188363
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Entity Type | Individual
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Provider Name | MARISSA CITARELLI
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Gender | Female
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 05/02/2024
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Provider Practice Location Address
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Address Line | 405 CHATHAM HEIGHTS RD
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City | FREDERICKSBURG
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State | VA
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Zip | 22405-2582
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Country | US
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Telephone | 540-300-6182
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Fax |
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Provider Business Mailing Address
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Address Line | 7202 GLEN FOREST DR STE 200
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City | RICHMOND
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State | VA
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Zip | 23226-3780
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Country | US
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Telephone | 804-673-2024
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Fax | 804-673-1796
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110008078
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License Number State | VA
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