Healthcare Provider Details

I. General information

NPI: 1780748822
Provider Name (Legal Business Name): DANIEL JON MERENSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MAPLE AVE W
VIENNA VA
22180-5727
US

IV. Provider business mailing address

PO BOX 791775
BALTIMORE MD
21279-1775
US

V. Phone/Fax

Practice location:
  • Phone: 703-938-5300
  • Fax: 703-242-0726
Mailing address:
  • Phone: 470-276-7931
  • Fax: 470-276-9046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD32709
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101058211
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: