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NPI Code Detail

MEDICARE: GINA LOUISE GALLIZZI M.D.

MEDICARE: GINA LOUISE GALLIZZI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianMD.29252AL
2208000000XPediatrics Physician0101252251VA

General Provider Information

NPI Number : 1306049705
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINA LOUISE GALLIZZI M.D.
Provider Business Mailing Address
First Line : 101 HOSPITAL CENTER BLVD
Second Line :
City : STAFFORD
State : VA
Zip : 22554-6200
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 101 HOSPITAL CENTER BLVD
Second Line :
City : STAFFORD
State : VA
Zip : 22554-6200
Country : US
Telephone Number : 813-786-8261
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2007
Last Update Date : 07/13/2012

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