Provider Demographics
NPI:1225089378
Name:DESMAN, ERIC
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:DESMAN
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 1:2501 PARKERS LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3209
Mailing Address - Country:US
Mailing Address - Phone:703-664-7218
Mailing Address - Fax:703-664-7317
Practice Address - Street 1:2501 PARKERS LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3209
Practice Address - Country:US
Practice Address - Phone:703-664-7218
Practice Address - Fax:703-664-7317
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055736208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6900780Medicaid
VAP00134671OtherRAILROAD MEDICARE
VAP00134671OtherRAILROAD MEDICARE