Provider Demographics
NPI:1598711426
Name:CARPOUSIS, DEAN (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:CARPOUSIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 COLUMBIA PIKE
Mailing Address - Street 2:SUITE 131
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-4547
Mailing Address - Country:US
Mailing Address - Phone:703-979-1777
Mailing Address - Fax:703-979-8258
Practice Address - Street 1:2001 COLUMBIA PIKE
Practice Address - Street 2:SUITE 131
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-4547
Practice Address - Country:US
Practice Address - Phone:703-979-1777
Practice Address - Fax:703-979-8258
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034067174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB94818Medicare UPIN
419597M42Medicare PIN