1891798849 NPI number — JOHN S PULIZZI JR. M.D.

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	PULIZZI
Provider First Name	:	JOHN
Provider Middle Name	:	S
Provider Name Prefix Text	:
Provider Name Suffix Text	:	JR.
Provider Credential Text	:	M.D.
Provider Gender Code	:	M

Provider Other Organization Name	:
Provider Other Organization Name Type Code	:
Provider Other Last Name	:
Provider Other First Name	:
Provider Other Middle Name	:
Provider Other Name Prefix Text	:
Provider Other Name Suffix Text	:
Provider Other Credential Text	:
Provider Other Last Name Type Code	:

NPI Number	:	1891798849
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	07/09/2007
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
NPI Reactivation Date	:

Provider First Line Business Mailing Address	:	3450 N BEAUREGARD ST
Provider Second Line Business Mailing Address	:	STE 1
Provider Business Mailing Address City Name	:	ALEXANDRIA
Provider Business Mailing Address State Name	:	VA
Provider Business Mailing Address Postal Code	:	223021200
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	7038207000
Provider Business Mailing Address Fax Number	:	7039310059

Provider First Line Business Practice Location Address	:	3450 N BEAUREGARD ST
Provider Second Line Business Practice Location Address	:	STE 1
Provider Business Practice Location Address City Name	:	ALEXANDRIA
Provider Business Practice Location Address State Name	:	VA
Provider Business Practice Location Address Postal Code	:	223021200
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	7038207000
Provider Business Practice Location Address Fax Number	:	7039310059
Provider Enumeration Date	:	05/23/2005

Authorized Official Last Name	:
Authorized Official First Name	:
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Authorized Official Title or Position	:
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• Taxonomy code: 208D00000X , with the licence number:  0101016313 , registered in the state of VA .

• Identifier: 035935 . This is a "ANTHEM ID" identifier , issued by the state of ( VA ) . This identifiers is of the category "".
• Identifier: 246820 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "".
• Identifier: 0002 . This is a "B/C INDIVIDUAL #" identifier , issued by the state of ( VA ) . This identifiers is of the category "".
• Identifier: 4088438 . This is a "AETNA ID" identifier , issued by the state of ( VA ) . This identifiers is of the category "".
• Identifier: D18029 , issued by the state of ( VA ) . This identifiers is of the category "".
• Identifier: 408722 . This is a "GROUP ID" identifier , issued by the state of ( VA ) . This identifiers is of the category "".
• Identifier: 2156 . This is a "B/C GROUP #" identifier , issued by the state of ( VA ) . This identifiers is of the category "".