Individual
PETER PAGANUSSI
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) 776-3111
(904) 346-0113
Mailing address
PO BOX 75567, BALTIMORE, MD 21275-5567
(703) 205-9790
(904) 346-0113
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101043880
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001
BCBS
VA
05
—
6063551
—
VA
01
—
930047718
RAILROAD MEDICARE
VA
Enumeration date
05/31/2006
Last updated
07/15/2008
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