Healthcare Provider Details

I. General information

NPI: 1285745810
Provider Name (Legal Business Name): CHARLES PARENTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAPLE AVE E
VIENNA VA
22180-5723
US

IV. Provider business mailing address

100 MAPLE AVE E
VIENNA VA
22180-5723
US

V. Phone/Fax

Practice location:
  • Phone: 703-938-5300
  • Fax: 703-242-0726
Mailing address:
  • Phone: 703-938-5300
  • Fax: 703-242-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101222081
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: