Basic Information
Provider Information
NPI: 1497323182
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GILSON
FirstName: GENEVIEVE
MiddleName: FLORENCE
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1919 CLARENDON BLVD APT 442
Address2:  
City: ARLINGTON
State: VA
PostalCode: 222012934
CountryCode: US
TelephoneNumber: 2028344216
FaxNumber:  
Practice Location
Address1: 3300 GALLOWS RD
Address2:  
City: FALLS CHURCH
State: VA
PostalCode: 220423307
CountryCode: US
TelephoneNumber: 7037764001
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/17/2021
LastUpdateDate: 06/17/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/17/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X0116035472VAY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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