Provider Demographics
NPI:1538664347
Name:SOWASH, MADELEINE GABRIELLE (MD)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:GABRIELLE
Last Name:SOWASH
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 1:1525 WILSON BLVD STE 100&125
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2411
Mailing Address - Country:US
Mailing Address - Phone:703-966-7127
Mailing Address - Fax:
Practice Address - Street 1:1525 WILSON BLVD STE 100&125
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2411
Practice Address - Country:US
Practice Address - Phone:703-966-7127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101278222207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology