Provider Demographics
NPI:1952562886
Name:GARGIULO, JEANINE MARIE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:JEANINE
Middle Name:MARIE
Last Name:GARGIULO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2501 PARKERS LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3209
Mailing Address - Country:US
Mailing Address - Phone:703-892-6500
Mailing Address - Fax:703-799-5989
Practice Address - Street 1:2501 PARKERS LN
Practice Address - Street 2:SUITE 200
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3209
Practice Address - Country:US
Practice Address - Phone:703-892-6500
Practice Address - Fax:703-799-5989
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110-002806363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical