Provider Demographics
NPI:1740231554
Name:POSTELNEK, DAVID L (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:POSTELNEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3992 BRIARBUSH WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3853
Mailing Address - Country:US
Mailing Address - Phone:703-503-8403
Mailing Address - Fax:
Practice Address - Street 1:2300 OPITZ BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3311
Practice Address - Country:US
Practice Address - Phone:703-670-1313
Practice Address - Fax:800-536-8431
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051870207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5833353Medicaid
VA1740231554Medicaid
VA1740231554Medicaid
VAG21184Medicare UPIN
VA015749V21Medicare PIN
VA006098R57Medicare PIN
VA015748V68Medicare PIN
VA002667R55Medicare PIN