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General NPI Number Information
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NPI Number | 1821153172
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Entity Type | Individual
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Provider Name | JOHN R VROOM MD
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Gender | Male
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 6501LOISDALE COURT
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City | SPRINGFIELD
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State | VA
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Zip | 22150-1885
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Country | US
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Telephone | 703-922-1283
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Fax | 703-922-1041
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Provider Business Mailing Address
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Address Line | KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP 2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANCE
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City | ROCKVILLE
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State | MD
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Zip | 20852-4908
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Country | US
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Telephone | 301-816-6650
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Fax | 301-816-6308
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number | D0020026
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number | 0101020960
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number | MD6449
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License Number State | DC
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