Healthcare Provider Details

I. General information

NPI: 1982097648
Provider Name (Legal Business Name): DANIEL JOSEPH RAUSA D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 ROLAND CLARKE PL STE 200
RESTON VA
20191-1445
US

IV. Provider business mailing address

1939 ROLAND CLARKE PL STE 200
RESTON VA
20191-1445
US

V. Phone/Fax

Practice location:
  • Phone: 703-766-2650
  • Fax: 703-766-2654
Mailing address:
  • Phone: 703-766-2650
  • Fax: 703-766-2654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0102204575
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: