Healthcare Provider Details

I. General information

NPI: 1962963058
Provider Name (Legal Business Name): RACHEL ELIZABETH MODARELLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8280 WILLOW OAKS CORPORATE DR STE 300
FAIRFAX VA
22031-4526
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-4300
  • Fax: 571-665-6771
Mailing address:
  • Phone: 571-423-5699
  • Fax: 571-423-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number0101285263
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101285263
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: