MEDICARE: DR. KURT LAURENCE MAGGIO 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
1	207N00000X	Dermatology Physician	0101058908	VA
2	207ND0101X	MOHS-Micrographic Surgery Physician	0101058908	VA
3	207NS0135X	Procedural Dermatology Physician	0101058908	VA

General Provider Information

NPI Number	:	1598787756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KURT LAURENCE MAGGIO M.D.

Provider Business Mailing Address
First Line	:	1611 8TH PL
Second Line	:
City	:	MCLEAN
State	:	VA
Zip	:	22101-4615
Country	:	US
Telephone Number	:	571-366-0456
Fax Number	:	703-753-9863

Provider Business Practice Location Address
First Line	:	7512 GARDNER PARK DR
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3414
Country	:	US
Telephone Number	:	703-753-9860
Fax Number	:	703-753-9863

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	08/03/2011

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