Healthcare Provider Details

I. General information

NPI: 1629234737
Provider Name (Legal Business Name): ADRIENNE N DREYFUSS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ADRIENNE NORTH

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 MAPLE AVENUE WEST STE. 5
VIENNA VA
20180
US

IV. Provider business mailing address

410 MAPLE AVENUE WEST STE. 5
VIENNA VA
20180
US

V. Phone/Fax

Practice location:
  • Phone: 703-938-2244
  • Fax: 703-938-3669
Mailing address:
  • Phone: 703-938-2244
  • Fax: 703-938-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.127392
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: