Provider Demographics
NPI:1609074459
Name:ENDOCRINOLOGY AND INFECTIOUS
Entity Type:Organization
Organization Name:ENDOCRINOLOGY AND INFECTIOUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-430-6211
Mailing Address - Street 1:6035 BURKE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3750
Mailing Address - Country:US
Mailing Address - Phone:703-978-1196
Mailing Address - Fax:703-978-7762
Practice Address - Street 1:21475 RIDGETOP CIR STE 350
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-6580
Practice Address - Country:US
Practice Address - Phone:703-430-6211
Practice Address - Fax:703-430-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057623207RE0101X
VA0101053112207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CK5247OtherMEDICARE, RAILROAD
CK5247OtherMEDICARE, RAILROAD
DCG01846Medicare PIN