Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 0101018078 | VA |
NPI | 1558485474 |
---|---|
Provider Name | Dr. Tony Tsitos |
First Address | Annandale, VA 22003-2923 |
Second Address | Annandale, VA 22003-2923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2007 |
Last Update Date | 16/05/2012 |