Provider Demographics
NPI:1659397073
Name:SATOSKAR, REBECCA THERESA (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:THERESA
Last Name:SATOSKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:THERESA
Other - Last Name:SCUDIERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:243 CHURCH STREET
Mailing Address - Street 2:SUITE 200C
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4434
Mailing Address - Country:US
Mailing Address - Phone:703-938-5700
Mailing Address - Fax:703-938-4467
Practice Address - Street 1:243 CHURCH STREET
Practice Address - Street 2:SUITE 200C
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4434
Practice Address - Country:US
Practice Address - Phone:703-938-5700
Practice Address - Fax:703-938-4467
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246518207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113530OtherIL STATE LIC
I58769Medicare UPIN