Provider Demographics
NPI:1629117155
Name:CROVATO, GINA M (AUD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:CROVATO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6862 ELM ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3897
Mailing Address - Country:US
Mailing Address - Phone:703-748-3300
Mailing Address - Fax:703-748-3311
Practice Address - Street 1:6862 ELM ST
Practice Address - Street 2:SUITE 120
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3897
Practice Address - Country:US
Practice Address - Phone:703-748-3300
Practice Address - Fax:703-748-3311
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001190237600000X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist