Provider Demographics
NPI:1902049000
Name:BUONCRISTIANO-THAI, GLORIA (BA)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:
Last Name:BUONCRISTIANO-THAI
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:BUONCRISTIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:110 HATCHER CT
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-2848
Mailing Address - Country:US
Mailing Address - Phone:757-232-2162
Mailing Address - Fax:
Practice Address - Street 1:110 HATCHER CT
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-2848
Practice Address - Country:US
Practice Address - Phone:757-232-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA020649332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies