Healthcare Provider Details

I. General information

NPI: 1841282803
Provider Name (Legal Business Name): ROBERT N DEANGELIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8346 TRAFORD LN ROOM 101
SPRINGFIELD VA
22152-1600
US

IV. Provider business mailing address

8346 TRAFORD LN ROOM 101
SPRINGFIELD VA
22152-1600
US

V. Phone/Fax

Practice location:
  • Phone: 703-451-8777
  • Fax: 703-451-6936
Mailing address:
  • Phone: 703-451-8777
  • Fax: 703-451-6936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101019234
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: