Provider Demographics
NPI:1366838104
Name:GUGINO, NATALIE JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:JEAN
Last Name:GUGINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10560 MAIN STREET
Mailing Address - Street 2:SUITE 410-I
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:571-276-4179
Mailing Address - Fax:571-934-3104
Practice Address - Street 1:10560 MAIN STREET
Practice Address - Street 2:SUITE 410-I
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:571-276-4179
Practice Address - Fax:571-934-3104
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012665042084P0800X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program