Provider Demographics
NPI:1841282803
Name:DEANGELIS, ROBERT N (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:N
Last Name:DEANGELIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8346 TRAFORD LN
Mailing Address - Street 2:ROOM 101
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1600
Mailing Address - Country:US
Mailing Address - Phone:703-451-8777
Mailing Address - Fax:703-451-6936
Practice Address - Street 1:8346 TRAFORD LN
Practice Address - Street 2:ROOM 101
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1600
Practice Address - Country:US
Practice Address - Phone:703-451-8777
Practice Address - Fax:703-451-6936
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101019234207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
6356OtherTRICARE
B572OtherBCBS
0300045OtherUHC
1581OtherANTHEM
B572OtherBCBS
6356OtherTRICARE