Individual
ENRICO A GIANGERUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4660 KENMORE AVENUE, SUITE 305, ALEXANDRIA, VA 22304-1306
(703) 751-5763
(703) 370-8704
Mailing address
224D CORNWALL ST NW STE 403, LEESBURG, VA 20176-2704
(703) 737-6010
(571) 291-9786
Taxonomy
Speciality
Code
Description
License number
State
207ZB0001X
Blood Banking & Transfusion Medicine Physician
0101258831
VA
207ZB0001X
Blood Banking & Transfusion Medicine Physician
D0044362
MD
207ZC0006X
Clinical Pathology Physician
0101258831
VA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
0101258831
VA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
D0044362
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135291100
—
MD
05
—
1568560134
—
VA
05
—
30016323590001
—
VA
01
—
61489901
BLUE SHIELD
MD
01
—
W2270004
GHI
DC
Enumeration date
09/20/2006
Last updated
12/11/2023
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