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General NPI Number Information
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NPI Number | 1679194641
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Entity Type | Organization
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Legal Business Name | VITALITY MEDICAL INFUSIONS LLC
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Dates
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Enumeration Date | 05/01/2020
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 5530 WISCONSIN AVE STE 1640
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City | CHEVY CHASE
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State | MD
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Zip | 20815-4305
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Country | US
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Telephone | 240-630-8254
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Fax |
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Provider Business Mailing Address
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Address Line | 5530 WISCONSIN AVE STE 1640
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City | CHEVY CHASE
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State | MD
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Zip | 20815-4305
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLOTTE E FOULKES DEROMERO
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Credential | CRNA
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Telephone | 202-427-5382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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