Provider Demographics
NPI:1548236185
Name:LEDOUX-PASCUCCI, MICHELE L (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:L
Last Name:LEDOUX-PASCUCCI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12400 FAIRFAX STATION RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-1633
Mailing Address - Country:US
Mailing Address - Phone:703-965-7119
Mailing Address - Fax:
Practice Address - Street 1:A.T. AUGUSTA MILITARY MEDICAL CENTER
Practice Address - Street 2:9300 DEWITT LOOP
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:703-805-8127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201559207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
H89064Medicare UPIN