Provider Demographics
NPI:1609071299
Name:DANIELSON, ROXANNE NICOLE (MD MPH MS)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:NICOLE
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:MD MPH MS
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:NICOLE
Other - Last Name:LANDESMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD MPH MS
Mailing Address - Street 1:12038 CHASE CROSSING CIR
Mailing Address - Street 2:APT 403
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4764
Mailing Address - Country:US
Mailing Address - Phone:617-320-8756
Mailing Address - Fax:
Practice Address - Street 1:NATIONAL NAVAL MEDICAL CTR
Practice Address - Street 2:8901 WISCONSIN AVE
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-319-8278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA010244208208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program