Healthcare Provider Details

I. General information

NPI: 1154631356
Provider Name (Legal Business Name): PETER THOMAS TROELL JR. MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10777 MAIN ST SUITE 211
FAIRFAX VA
22030-6903
US

IV. Provider business mailing address

6092 9TH PL N
ARLINGTON VA
22205-1608
US

V. Phone/Fax

Practice location:
  • Phone: 703-246-2433
  • Fax: 703-385-3681
Mailing address:
  • Phone: 202-384-7395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101242623
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: