Provider Demographics
NPI:1295805935
Name:DELEON, REMEDIOS LOPEZ (MD)
Entity type:Individual
Prefix:DR
First Name:REMEDIOS
Middle Name:LOPEZ
Last Name:DELEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8638 CENTREVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5264
Mailing Address - Country:US
Mailing Address - Phone:703-361-2930
Mailing Address - Fax:703-361-0910
Practice Address - Street 1:8638 CENTREVILLE RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5264
Practice Address - Country:US
Practice Address - Phone:703-361-2930
Practice Address - Fax:703-361-0910
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101049875207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA101049875OtherVIRGINIA LICENSE NUMBER
VA005612195Medicaid
VAF68046Medicare UPIN
VA110004950Medicare PIN