Provider Demographics
NPI:1871669960
Name:PALUMBO, PATRICK WILLIAM (MD, AAPS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:WILLIAM
Last Name:PALUMBO
Suffix:
Gender:M
Credentials:MD, AAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 ELDEN ST
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4818
Mailing Address - Country:US
Mailing Address - Phone:571-665-4000
Mailing Address - Fax:
Practice Address - Street 1:8206 LEESBURG PIKE STE 401
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2614
Practice Address - Country:US
Practice Address - Phone:703-356-5666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044923207P00000X, 208600000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA138097OtherANTHEM INSURANCE
VA84 1633951OtherTAX ID #
VA0005406118OtherAETNA PPO
VA3559401OtherAETNA HMO
VA010076633OtherVA MCDE
VAC09143 00W011F01Medicare ID - Type Unspecified
VA84 1633951OtherTAX ID #