Provider Demographics
NPI:1598825655
Name:VALLONE, ERIC SANTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:SANTO
Last Name:VALLONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3911 OLD LEE HWY
Mailing Address - Street 2:#41C
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2434
Mailing Address - Country:US
Mailing Address - Phone:703-352-7100
Mailing Address - Fax:703-591-7106
Practice Address - Street 1:3911 OLD LEE HWY
Practice Address - Street 2:#41C
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2434
Practice Address - Country:US
Practice Address - Phone:703-352-7100
Practice Address - Fax:703-591-7106
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101059057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH54311Medicare UPIN
VA00A750D42Medicare PIN