Healthcare Provider Details

I. General information

NPI: 1821153172
Provider Name (Legal Business Name): JOHN R VROOM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501LOISDALE COURT
SPRINGFIELD VA
22150-1885
US

IV. Provider business mailing address

KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP 2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANCE
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 703-922-1283
  • Fax: 703-922-1041
Mailing address:
  • Phone: 301-816-6650
  • Fax: 301-816-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberD0020026
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number0101020960
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberMD6449
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: