Provider Demographics
NPI:1568866671
Name:PEDEMONTE, LUIS ALBERTO (ACNP)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ALBERTO
Last Name:PEDEMONTE
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45572 SILVER POND SQ
Mailing Address - Street 2:APT 201
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6589
Mailing Address - Country:US
Mailing Address - Phone:571-214-3724
Mailing Address - Fax:
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:ORIGINAL BUILDING, 2ND FLOOR
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-4958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171985363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care