Healthcare Provider Details

I. General information

NPI: 1235578014
Provider Name (Legal Business Name): ROCHELLE P MASCARENHAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROCHELLE P COELHO M.D.

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS ROAD
FALLS CHURCH VA
22042-3300
US

IV. Provider business mailing address

8903 WAITES WAY
LORTON VA
22079-1734
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-6652
  • Fax:
Mailing address:
  • Phone: 804-380-3857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116025599
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: