Healthcare Provider Details

I. General information

NPI: 1235304437
Provider Name (Legal Business Name): JOHN PAUL VERDERESE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 PROSPERITY AVE STE 100
FAIRFAX VA
22031-4354
US

IV. Provider business mailing address

2740 PROSPERITY AVE STE 100
FAIRFAX VA
22031-4354
US

V. Phone/Fax

Practice location:
  • Phone: 571-623-3390
  • Fax: 703-204-9020
Mailing address:
  • Phone: 571-623-3390
  • Fax: 703-204-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101242589
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: