Individual
LORI JEAN MACIULLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6707 OLD DOMINION DR, SUITE 300, MCLEAN, VA 22101-4504
(703) 288-4330
(703) 556-0347
Mailing address
6707 OLD DOMINION DR, SUITE 300, MCLEAN, VA 22101-4504
(703) 288-4330
(703) 556-0347
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
01001043172
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
259156
ANTHEM BCBS
VA
01
—
32070001
CAREFIRST BCBS
DC
01
—
4315636
AETNA
—
01
—
516252
MAMSI
—
Enumeration date
08/11/2006
Last updated
07/08/2014
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