Provider Demographics
NPI:1700866316
Name:BASS, RITA A (MD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:A
Last Name:BASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 MERRILEE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4416
Mailing Address - Country:US
Mailing Address - Phone:703-698-4483
Mailing Address - Fax:
Practice Address - Street 1:8926 WOODYARD RD
Practice Address - Street 2:SUITE 301
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4220
Practice Address - Country:US
Practice Address - Phone:301-856-3670
Practice Address - Fax:301-868-0129
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034430174400000X, 2085R0202X
MDD27202174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010292395Medicaid
MD761600700Medicaid
VA010331048Medicaid
VA010292417Medicaid
MD761600700Medicaid
VA300105450Medicare PIN
MDP00231169Medicare PIN
DC416693R04Medicare PIN
DCP00259532Medicare PIN
VA00X011N02Medicare PIN