Provider Demographics
NPI:1407951874
Name:DOSSOLA, JOSE MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MARIA
Last Name:DOSSOLA
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 1:5272 DAWES AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1404
Mailing Address - Country:US
Mailing Address - Phone:703-931-6900
Mailing Address - Fax:703-931-3627
Practice Address - Street 1:5272 DAWES AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1404
Practice Address - Country:US
Practice Address - Phone:703-931-6900
Practice Address - Fax:703-931-3627
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101024558207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVA 005681367Medicaid
80060OtherMAMSI/ALLIANCE
1426474007OtherCIGNA HEALTHCARE
0490285OtherAETNA HMO
4087840OtherAETNA PPO
DO170461Medicare ID - Type Unspecified
0490285OtherAETNA HMO