Provider Demographics
NPI:1336896703
Name:DU, MARIA GAO
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GAO
Last Name:DU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HUIFANG
Other - Middle Name:
Other - Last Name:GAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5927 GLEN EAGLES DR.
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407
Mailing Address - Country:US
Mailing Address - Phone:540-287-2672
Mailing Address - Fax:
Practice Address - Street 1:5927 GLEN EAGLES DR.
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407
Practice Address - Country:US
Practice Address - Phone:540-369-6039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121001033171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist