Provider Demographics
NPI:1396086781
Name:DE GEUS, ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:
Last Name:DE GEUS
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 1:1 ADMINISTRATION CIRCLE
Mailing Address - Street 2:BUILDING 1403
Mailing Address - City:CHINA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:93555
Mailing Address - Country:US
Mailing Address - Phone:760-939-8000
Mailing Address - Fax:
Practice Address - Street 1:3918 CENTREVILLE RD
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-3224
Practice Address - Country:US
Practice Address - Phone:703-665-7695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC210002873207Q00000X
VA0101257847207Q00000X, 207Q00000X
MD0095651207Q00000X
CO0069510207Q00000X
FL159311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine