Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 9174 | MD |
N | 213EG0000X | General Practice | 9174 | MD |
N | 1223P0700X | Prosthodontist | 0401008190 | VA |
NPI | 1154300044 |
---|---|
Provider Name | Dr. Gerald Anthony Santulli |
First Address | Alexandria, VA 22308-1800 |
Second Address | Washington, DC 20310-5802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 08/07/2007 |