Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | 0401410769 | VA |
N | 208200000X | Surgeon | 0401410769 | VA |
N | 208600000X | Surgeon | 0401410769 | VA |
NPI | 1164591970 |
---|---|
Provider Name | Dr. Craig Ernest Vigliante |
First Address | Leesburg, VA 20176 |
Second Address | Leesburg, VA 20176 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |