Provider Demographics
NPI:1861545899
Name:GAILITIS, SANDRA INGRIDA (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:INGRIDA
Last Name:GAILITIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6870 ELM ST STE 301
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3828
Mailing Address - Country:US
Mailing Address - Phone:703-448-8490
Mailing Address - Fax:703-448-1124
Practice Address - Street 1:6870 ELM ST STE 301
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3828
Practice Address - Country:US
Practice Address - Phone:703-448-8490
Practice Address - Fax:703-448-1124
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101038133207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine