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General NPI Number Information
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NPI Number | 1790953149
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Entity Type | Organization
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Legal Business Name | JAMES M DESIMONE
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 7015 E MANCHESTER BLVD
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City | ALEXANDRIA
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State | VA
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Zip | 22310
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Country | US
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Telephone | 757-483-7706
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Fax |
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Provider Business Mailing Address
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Address Line | 422 GARRISONVILLE ROAD
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City | GARRISONVILLE
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State | VA
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Zip | 22554
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Country | US
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Telephone | 757-483-7706
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. ANNETTE JOHN
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Credential |
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Telephone | 757-483-7706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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