Healthcare Provider Details

I. General information

NPI: 1700257839
Provider Name (Legal Business Name): INFECTIOUS DISEASES PHYSICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3289 WOODBURN RD STE 200
ANNANDALE VA
22003-7347
US

IV. Provider business mailing address

3289 WOODBURN RD STE 200
ANNANDALE VA
22003-7347
US

V. Phone/Fax

Practice location:
  • Phone: 703-560-7900
  • Fax:
Mailing address:
  • Phone: 703-560-7900
  • Fax: 703-560-8408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024172994
License Number StateVA

VIII. Authorized Official

Name: STEVE PORETZ
Title or Position: COO
Credential: RN, MSHA
Phone: 703-560-7900