Provider Demographics
NPI:1023176153
Name:EARLE, RONA HARTHILL
Entity type:Individual
Prefix:
First Name:RONA
Middle Name:HARTHILL
Last Name:EARLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 HAMAKER CT STE B102
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2220
Mailing Address - Country:US
Mailing Address - Phone:703-573-4072
Mailing Address - Fax:703-572-2153
Practice Address - Street 1:3020 HAMAKER CT STE B102
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2220
Practice Address - Country:US
Practice Address - Phone:703-573-4072
Practice Address - Fax:703-572-2153
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0004573175OtherAETNA
VA3804OtherCAREFIRST BCBS
VA6021620Medicaid
VA17143OtherNCPPO
VA113266OtherANTHEM BCBS
VACIGNAOther541932424 0002
VA3804OtherCAREFIRST BCBS
VA546595Medicare ID - Type Unspecified