Provider Demographics
NPI:1255599742
Name:DELASOBERA, BRONSON ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:BRONSON
Middle Name:ELIZABETH
Last Name:DELASOBERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6858 OLD DOMINION DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3899
Mailing Address - Country:US
Mailing Address - Phone:703-288-2790
Mailing Address - Fax:703-997-7272
Practice Address - Street 1:6858 OLD DOMINION DR
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3899
Practice Address - Country:US
Practice Address - Phone:703-288-2790
Practice Address - Fax:703-997-7272
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD039254207P00000X
DCFD2576366207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine