MEDICARE: MR. ROBERT N DEANGELIS MD

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	207N00000X	Dermatology Physician	0101019234	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	6356	OTHER	TRICARE
2	B572	OTHER	BCBS
3	0300045	OTHER	UHC
4	1581	OTHER	ANTHEM

General Provider Information

NPI Number	:	1841282803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT N DEANGELIS MD

Provider Business Mailing Address
First Line	:	8346 TRAFORD LN
Second Line	:	ROOM 101
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1600
Country	:	US
Telephone Number	:	703-451-8777
Fax Number	:	703-451-6936

Provider Business Practice Location Address
First Line	:	8346 TRAFORD LN
Second Line	:	ROOM 101
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1600
Country	:	US
Telephone Number	:	703-451-8777
Fax Number	:	703-451-6936

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/08/2007

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Directions to “ MR. ROBERT N DEANGELIS MD” Practice Location

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