Individual
MR. WIBISONO HARTOJO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-4401
(703) 776-7113
Mailing address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-4401
(703) 776-7113
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
003711
GA
207R00000X
Internal Medicine Physician
Primary
0101251159
VA
Other
Enumeration date
07/08/2009
Last updated
05/10/2021
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