Provider Demographics
NPI:1801824479
Name:GALLINI, MARC ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ROBERT
Last Name:GALLINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10105 HAMPTON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-2729
Mailing Address - Country:US
Mailing Address - Phone:703-643-1416
Mailing Address - Fax:
Practice Address - Street 1:9500 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-2124
Practice Address - Country:US
Practice Address - Phone:703-339-7788
Practice Address - Fax:703-339-5713
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5617928Medicaid
VA00A220W00Medicare ID - Type Unspecified
VAD06039Medicare UPIN
VA5617928Medicaid