Individual
DR. PHILIP J. O'DONNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
513 W BROAD ST, UNIT 100, FALLS CHURCH, VA 22046-3248
(703) 940-0000
(703) 782-0207
Mailing address
513 W BROAD ST, UNIT 100, FALLS CHURCH, VA 22046-3248
(703) 940-0000
(703) 782-0207
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101043748
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101043748
STATE LIC #
VA
01
—
G02788
MCR PCA GRP PTAN
VA
01
—
G02788P01
MEDICARE IND PTAN
VA
Enumeration date
03/30/2006
Last updated
12/12/2013
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