Healthcare Provider Details

I. General information

NPI: 1619142163
Provider Name (Legal Business Name): ANDREA MARIE O'DANIEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N GEORGE MASON DR SUITE#494
ARLINGTON VA
22205-3683
US

IV. Provider business mailing address

5225 POOKS HILL RD APT#1529N
BETHESDA MD
20814-2052
US

V. Phone/Fax

Practice location:
  • Phone: 703-717-4090
  • Fax: 703-717-4091
Mailing address:
  • Phone: 240-381-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number0101243353
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: