Lori Jean Maciulla, M.D.

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

01001043172 Issued in VA

Practice address

6707 Old Dominion Dr
Suite 300
McLean, VA 22101-4504

Phone

(703) 288-4330

Fax

(703) 556-0347

NPI assigned

Aug 11, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in DC, VA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Privia Medical Group, LLC

  • Internal Medicine Physician
  • Arlington, VA
  • NPI 1013042480

  DC, Gynecology, VA

  Medicare reassignment NPD
• Privia Medical Group, LLC

  • Pain Medicine (Psychiatry & Neurology) Physician
  • Rockville, MD
  • NPI 1811715436
  NPD
• Virginia Gynecologists, LTD

  • Obstetrics & Gynecology Physician
  • Vienna, VA
  • NPI 1962438119

  Gynecology

  NPD (past)
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404777600000",
    "number": "1528079837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6707 OLD DOMINION DR",
            "address_2": "SUITE 300",
            "city": "MCLEAN",
            "state": "VA",
            "postal_code": "221014504",
            "telephone_number": "703-288-4330",
            "fax_number": "703-556-0347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6707 OLD DOMINION DR",
            "address_2": "SUITE 300",
            "city": "MCLEAN",
            "state": "VA",
            "postal_code": "221014504",
            "telephone_number": "703-288-4330",
            "fax_number": "703-556-0347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACIULLA",
        "first_name": "LORI",
        "middle_name": "JEAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-11",
        "last_updated": "2014-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "VA",
            "license": "01001043172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "516252",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4315636",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "259156",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS",
            "identifier": "32070001",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jeanne Tedra Mahoney
• Rizwan A Malik, M.D.
• Manual Therapy Effects LLC
• Aizenhawar J Marrogi, M.D
• Alicia Martin

• All providers in McLean, VA
• Gynecology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.