Healthcare Provider Details

I. General information

NPI: 1295709079
Provider Name (Legal Business Name): CHRISTOPHER JOHN MALDARELLA P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS GEORGE WASHINGTON CVN 73
FPO VA
09550-2873
US

IV. Provider business mailing address

6713 BURBAGE LAKE CIR
SUFFOLK VA
23435-2902
US

V. Phone/Fax

Practice location:
  • Phone: 757-444-4907
  • Fax:
Mailing address:
  • Phone: 757-484-0263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: