Provider Demographics
NPI:1861500050
Name:DEBASS, BRICKTE L (MD)
Entity Type:Individual
Prefix:
First Name:BRICKTE
Middle Name:L
Last Name:DEBASS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3022 WILLIAMS DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031
Mailing Address - Country:US
Mailing Address - Phone:703-573-9800
Mailing Address - Fax:703-573-2959
Practice Address - Street 1:3833 N FAIRFAX DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203
Practice Address - Country:US
Practice Address - Phone:703-252-8863
Practice Address - Fax:703-525-2387
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2023-11-27
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Provider Licenses
StateLicense IDTaxonomies
VA0101222005207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110246253OtherRR MEDICARE
VA5874564Medicaid
7927G450Medicare PIN
110246253OtherRR MEDICARE