Provider Demographics
NPI:1134119290
Name:REPETA, RICHARD J JR (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:REPETA
Suffix:JR
Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:9501 FARRELL RD
Mailing Address - Street 2:ATTN: EMERGENCY DEPARTMENT
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5901
Mailing Address - Country:US
Mailing Address - Phone:703-805-0414
Mailing Address - Fax:703-805-0416
Practice Address - Street 1:9501 FARRELL RD
Practice Address - Street 2:ATTN: EMERGENCY DEPARTMENT
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5901
Practice Address - Country:US
Practice Address - Phone:703-805-0414
Practice Address - Fax:703-805-0416
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA158529207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine