Provider Demographics
NPI:1528211240
Name:JOHN D. DOPPELHEUER M.D. PC
Entity Type:Organization
Organization Name:JOHN D. DOPPELHEUER M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DOPPELHEUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-698-1197
Mailing Address - Street 1:3299 WOODBURN RD
Mailing Address - Street 2:SUITE 370
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1275
Mailing Address - Country:US
Mailing Address - Phone:703-698-1197
Mailing Address - Fax:703-698-9715
Practice Address - Street 1:3299 WOODBURN RD
Practice Address - Street 2:SUITE 370
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1275
Practice Address - Country:US
Practice Address - Phone:703-698-1197
Practice Address - Fax:703-698-9715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-25
Last Update Date:2008-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032817174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB94415Medicare UPIN