Provider Demographics
NPI:1073276853
Name:CHARLIP, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CHARLIP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11708 NEWBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3504
Mailing Address - Country:US
Mailing Address - Phone:703-862-2111
Mailing Address - Fax:
Practice Address - Street 1:11708 NEWBRIDGE CT
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3504
Practice Address - Country:US
Practice Address - Phone:703-862-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAE071805908146L00000X
363A00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant