Provider Demographics
NPI:1457352239
Name:PONTELL, DAVID L (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:PONTELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 HAMAKER CT
Mailing Address - Street 2:#340
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2237
Mailing Address - Country:US
Mailing Address - Phone:703-849-8400
Mailing Address - Fax:703-849-8448
Practice Address - Street 1:3025 HAMAKER CT
Practice Address - Street 2:#340
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2237
Practice Address - Country:US
Practice Address - Phone:703-849-8400
Practice Address - Fax:703-849-8448
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000756213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
059115OtherANTHEM
3307-0001OtherCAREFIRST
22674OtherMDIPA OPT CHOICE ALLIANCE
2700107OtherUNITED HEALTHCARE
VA09320300Medicaid
059115OtherANTHEM
G00455Medicare ID - Type Unspecified