Dmitri Gagarin

Medical doctor

Springfield, United States

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Full name

Dmitri Gagarin

Job Title

Medical Doctor

Location

Springfield, VA, USA

LIC ID

163171

Current License Expiration Date

31/01/2025

Original Date

23/09/2022

Professional Rank Code

Effective Date

23/09/2022

Board Action Indicator

License Status Description

CLEAR

License Active Status Description

ACTIVE

Country Description

Out of State

Practice Location Address Line 1

16000 JOHNSTON MEMORIAL DRIVE

Practice Location Address City

ABINGDON

Practice Location Address State

Practice Location Address Zipcode

24211

Mode Code

Dispensing Practitioner

Prescribing Indicator

Dispensing Indicator

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