Provider Demographics
NPI:1912154188
Name:MARCELO ANDREOLI MD
Entity Type:Organization
Organization Name:MARCELO ANDREOLI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-531-1054
Mailing Address - Street 1:2946 SLEEPY HOLLOW RD
Mailing Address - Street 2:STE 2D
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2003
Mailing Address - Country:US
Mailing Address - Phone:703-531-1054
Mailing Address - Fax:703-531-1090
Practice Address - Street 1:2946 SLEEPY HOLLOW RD
Practice Address - Street 2:STE 2D
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2003
Practice Address - Country:US
Practice Address - Phone:703-531-1054
Practice Address - Fax:703-531-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055708174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1255431375Medicaid