Provider Demographics
NPI:1366625261
Name:MARLENE M. PICCIO-AZARCON,MD,PC
Entity Type:Organization
Organization Name:MARLENE M. PICCIO-AZARCON,MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GUARINO
Authorized Official - Middle Name:
Authorized Official - Last Name:AZARCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-799-7308
Mailing Address - Street 1:2616 SHERWOOD HALL LN
Mailing Address - Street 2:STE. 402
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3100
Mailing Address - Country:US
Mailing Address - Phone:703-799-7308
Mailing Address - Fax:703-778-8300
Practice Address - Street 1:2616 SHERWOOD HALL LN
Practice Address - Street 2:STE. 402
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3100
Practice Address - Country:US
Practice Address - Phone:703-799-7308
Practice Address - Fax:703-778-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010377932080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty