Provider Demographics
NPI:1972177913
Name:TURISSINI, GREGORY ROBERT
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:ROBERT
Last Name:TURISSINI
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 1:1215 LEE ST.
Mailing Address - Street 2:MAIL STOP 800499
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0816
Mailing Address - Country:US
Mailing Address - Phone:434-924-5348
Mailing Address - Fax:
Practice Address - Street 1:29 JEFFERSON CT
Practice Address - Street 2:
Practice Address - City:ZION CROSSROADS
Practice Address - State:VA
Practice Address - Zip Code:22942-9602
Practice Address - Country:US
Practice Address - Phone:434-654-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
VA0102208588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program