Healthcare Provider Details

I. General information

NPI: 1326199837
Provider Name (Legal Business Name): RENATO DOCTOR DAING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 SHERWOOD HALL LN SUITE 404
ALEXANDRIA VA
22306-3100
US

IV. Provider business mailing address

2616 SHERWOOD HALL LN SUITE 404
ALEXANDRIA VA
22306-3100
US

V. Phone/Fax

Practice location:
  • Phone: 703-360-0300
  • Fax: 703-799-7074
Mailing address:
  • Phone: 703-360-0300
  • Fax: 703-799-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number0101233629
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: