Healthcare Provider Details

I. General information

NPI: 1982276697
Provider Name (Legal Business Name): BRYAN C ALDEGHI CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44045 RIVERSIDE PKWY
LEESBURG VA
20176-5101
US

IV. Provider business mailing address

11113 PUTMAN RD
THURMONT MD
21788-2748
US

V. Phone/Fax

Practice location:
  • Phone: 301-661-7117
  • Fax:
Mailing address:
  • Phone: 301-661-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number0136000716
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number204207
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: