Provider Demographics
NPI:1164478095
Name:PORETZ, DONALD M (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:M
Last Name:PORETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3289 WOODBURN RD
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6800
Mailing Address - Country:US
Mailing Address - Phone:703-560-7900
Mailing Address - Fax:703-560-8408
Practice Address - Street 1:3289 WOODBURN RD
Practice Address - Street 2:SUITE # 200
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6800
Practice Address - Country:US
Practice Address - Phone:703-560-7900
Practice Address - Fax:703-560-8408
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101018020207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6042376Medicaid
VAB93192Medicare UPIN