Provider Demographics
NPI:1245358803
Name:GIOVANNA MORENA M.D, P.C.
Entity type:Organization
Organization Name:GIOVANNA MORENA M.D, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GIOVANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-379-7215
Mailing Address - Street 1:1707 OSAGE ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-2607
Mailing Address - Country:US
Mailing Address - Phone:703-379-7215
Mailing Address - Fax:703-824-8212
Practice Address - Street 1:20749 RAINSBORO DR
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-2835
Practice Address - Country:US
Practice Address - Phone:703-723-1980
Practice Address - Fax:703-723-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD414632084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F05544Medicare UPIN
696734Medicare ID - Type Unspecified