Basic Information
| Provider Information | |||||||||
| NPI: | 1467466235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DILISI | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1625 N GEORGE MASON DR | ||||||||
| Address2: | SUITE 425 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222053683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037174400 | ||||||||
| FaxNumber: | 7037174401 | ||||||||
| Practice Location | |||||||||
| Address1: | 1625 N GEORGE MASON DR | ||||||||
| Address2: | SUITE 425 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222053683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037174400 | ||||||||
| FaxNumber: | 7037174401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 03/22/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2006-01167 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MA08492700 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0101245481 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2006-01167 | 01 | NC | MEDICAL LICENSE | OTHER | MA08492700 | 01 | NJ | MEDICAL LICENSE | OTHER | 5904418 | 05 | NC | MEDICAID |