Provider Demographics
NPI:1023162724
Name:AGOLINI, STEFANO FRANCO
Entity type:Individual
Prefix:
First Name:STEFANO
Middle Name:FRANCO
Last Name:AGOLINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 N LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3235
Mailing Address - Country:US
Mailing Address - Phone:703-823-4066
Mailing Address - Fax:703-823-4067
Practice Address - Street 1:4660 KENMORE AVE
Practice Address - Street 2:SUITE 419
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1313
Practice Address - Country:US
Practice Address - Phone:703-823-4066
Practice Address - Fax:703-823-4067
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057385208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1467475822OtherCORPORATE NPI
1467475822OtherCORPORATE NPI
490567Medicare ID - Type Unspecified