Provider Demographics
NPI:1518091453
Name:DEAN J STORER MD PC
Entity Type:Organization
Organization Name:DEAN J STORER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:STORER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-379-7215
Mailing Address - Street 1:44050-195 ASHBURN PLAZA
Mailing Address - Street 2:BOX 710
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147
Mailing Address - Country:US
Mailing Address - Phone:703-723-1980
Mailing Address - Fax:
Practice Address - Street 1:6000 STEVENSON AVE STE 208
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3526
Practice Address - Country:US
Practice Address - Phone:703-379-7215
Practice Address - Fax:202-265-7804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-0451752084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCB571OtherCAREFIRST BC BS
VA007709889Medicaid
VA007709889Medicaid
VAC89222Medicare UPIN
DC591559Medicare ID - Type UnspecifiedDC METRO