Provider Demographics
NPI:1750328548
Name:TRIBASTONE, ANDREA DENISE (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DENISE
Last Name:TRIBASTONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:DENISE
Other - Last Name:GUBSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13198 JAMES MADISON HWY
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:VA
Mailing Address - Zip Code:22960-2851
Mailing Address - Country:US
Mailing Address - Phone:434-672-3010
Mailing Address - Fax:
Practice Address - Street 1:2503 S SEMINOLE TRL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:VA
Practice Address - Zip Code:22727-2690
Practice Address - Country:US
Practice Address - Phone:540-672-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H27696Medicare UPIN
VA00X569M04Medicare PIN
VAP01176677Medicare PIN