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General NPI Number Information
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NPI Number | 1932254356
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Entity Type | Individual
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Provider Name | JUSTIN RODANTE PAC
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Gender | Male
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 10 CENTER DRIVE BUILDING 10 CRC MSC 1476 ROOM 5-3140
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City | BETHESDA
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State | MD
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Zip | 20892-0001
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Country | US
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Telephone | 301-827-6417
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Fax |
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Provider Business Mailing Address
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Address Line | 10 CENTER DRIVE MSC 1476 ROOM 5-3140
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City | BETHESDA
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State | MD
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Zip | 20892-0001
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Country | US
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Telephone | 301-827-6417
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA30321
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C05297
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License Number State | MD
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