1245358803 NPI number — GIOVANNA MORENA M.D, P.C.

Table of content: (NPI 1245358803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245358803 NPI number — GIOVANNA MORENA M.D, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GIOVANNA MORENA M.D, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1245358803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1707 OSAGE ST
Provider Second Line Business Mailing Address:
SUITE 404
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22302-2607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-379-7215
Provider Business Mailing Address Fax Number:
703-824-8212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20749 RAINSBORO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHBURN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20147-2835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-723-1980
Provider Business Practice Location Address Fax Number:
703-723-1994
Provider Enumeration Date:
03/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORENA
Authorized Official First Name:
GIOVANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
PROPRIETOR
Authorized Official Telephone Number:
703-379-7215

Provider Taxonomy Codes

  • Taxonomy code: 2084P0805X , with the licence number:  D41463 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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