Healthcare Provider Details

I. General information

NPI: 1225012214
Provider Name (Legal Business Name): BARTHOLOMEW MICHAEL LOPRESTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20209 SENTARA WAY STE 200
CARROLLTON VA
23314-3573
US

IV. Provider business mailing address

20209 SENTARA WAY STE 200
CARROLLTON VA
23314-3573
US

V. Phone/Fax

Practice location:
  • Phone: 757-542-2000
  • Fax: 757-542-2001
Mailing address:
  • Phone: 757-542-2000
  • Fax: 757-542-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101037607
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: