Provider Demographics
NPI:1255431375
Name:ANDREOLI, HUMBERTO MARCELO (MD)
Entity type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:MARCELO
Last Name:ANDREOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARCELO
Other - Middle Name:
Other - Last Name:ANDREOLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8308 OLD COURTHOUSE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3863
Mailing Address - Country:US
Mailing Address - Phone:703-531-1090
Mailing Address - Fax:703-531-1091
Practice Address - Street 1:8308 OLD COURTHOUSE RD
Practice Address - Street 2:SUITE A
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3863
Practice Address - Country:US
Practice Address - Phone:703-531-1090
Practice Address - Fax:703-531-1091
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055708207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA80705OtherGREAT WEST PROVIDER ID
VAK180OtherCAREFIRST PROVIDER ID
VA5855677OtherAETNA
VA2390361OtherMAMSI PROVIDER ID
VA281585OtherAMERIGROUP PROVIDER ID
VA144125OtherANTHEM PROVIDER ID
VA243793OtherKAISER PROVIDER ID
VA2359444OtherCIGNA PROVIDER ID
VA010108624Medicaid
VA3829934OtherAETNA HMO
VA010108624Medicaid