MEDICARE: DR. DEIRDRE MAULL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0401008919	VA

General Provider Information

NPI Number	:	1679137608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEIRDRE MAULL

Provider Business Mailing Address
First Line	:	6845 ELM ST STE 505
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-3822
Country	:	US
Telephone Number	:	703-556-9400
Fax Number	:	703-556-9400

Provider Business Practice Location Address
First Line	:	6845 ELM ST STE 505
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-3822
Country	:	US
Telephone Number	:	703-556-9400
Fax Number	:	703-556-9400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2019
Last Update Date	:	04/25/2019

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Directions to “ DR. DEIRDRE MAULL ” Practice Location

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