Provider Demographics
NPI:1952626400
Name:DEMULDER, DANIELLE OLIVIA (MD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:OLIVIA
Last Name:DEMULDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:OLIVIA
Other - Last Name:KAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3300 GALLOWS RD
Mailing Address - Street 2:DEPT OF MEDICINE
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3307
Mailing Address - Country:US
Mailing Address - Phone:703-776-3582
Mailing Address - Fax:703-776-3020
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:DEPT OF MEDICINE
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-3582
Practice Address - Fax:703-776-3020
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-27
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD816162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program