Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 0101039372 | VA |
NPI | 1912062142 |
---|---|
Provider Name | Dr. Donald E. Bartlett JR. |
First Address | Fairfax, VA 22033-1622 |
Second Address | Chantilly, VA 20151-2923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/07/2007 |