Provider Demographics
NPI:1679688394
Name:GERONA, LUCILLE LYNN (MD)
Entity Type:Individual
Prefix:MS
First Name:LUCILLE
Middle Name:LYNN
Last Name:GERONA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9430 FORESTWOOD LANE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110
Mailing Address - Country:US
Mailing Address - Phone:703-365-0227
Mailing Address - Fax:703-365-0332
Practice Address - Street 1:9430 FORESTWOOD LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:703-365-0227
Practice Address - Fax:703-365-0332
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044578208000000X
VA0101242021208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA403986OtherANTHEM