1083751648 NPI number — DR. LINDA ROSE GOGLIA PHD

Table of content: DR. LINDA ROSE GOGLIA PHD (NPI 1083751648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083751648 NPI number — DR. LINDA ROSE GOGLIA PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOGLIA
Provider First Name:
LINDA
Provider Middle Name:
ROSE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1083751648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11333 SUNSET HILLS ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RESTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20190-5205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-620-9052
Provider Business Mailing Address Fax Number:
703-464-0507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11333 SUNSET HILLS ROAD
Provider Second Line Business Practice Location Address:
LINDA R GOGLIA PHD
Provider Business Practice Location Address City Name:
RESTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20190-5205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-620-9052
Provider Business Practice Location Address Fax Number:
703-464-0507
Provider Enumeration Date:
01/31/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  0810001488 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)