Healthcare Provider Details

I. General information

NPI: 1518091453
Provider Name (Legal Business Name): DEAN J STORER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 STEVENSON AVE STE 208
ALEXANDRIA VA
22304-3526
US

IV. Provider business mailing address

44050-195 ASHBURN PLAZA BOX 710
ASHBURN VA
20147
US

V. Phone/Fax

Practice location:
  • Phone: 703-379-7215
  • Fax: 202-265-7804
Mailing address:
  • Phone: 703-723-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number0101-045175
License Number StateVA

VIII. Authorized Official

Name: DEAN JAMES STORER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 703-379-7215