Provider Demographics
NPI:1942274741
Name:DEARDORFF, DYLAN DRUE (MD)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:DRUE
Last Name:DEARDORFF
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 1:3713 FETTLER PARK DR
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-2048
Mailing Address - Country:US
Mailing Address - Phone:571-931-6037
Mailing Address - Fax:571-931-6039
Practice Address - Street 1:3713 FETTLER PARK DR
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-2048
Practice Address - Country:US
Practice Address - Phone:571-931-6037
Practice Address - Fax:571-931-6039
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048502207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E91819Medicare UPIN
150055D67Medicare PIN
DE765467Medicare ID - Type UnspecifiedDC METRO MEDICARE