Provider Demographics
NPI:1184779076
Name:ROUT, PREETI (MD)
Entity type:Individual
Prefix:
First Name:PREETI
Middle Name:
Last Name:ROUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7342 HOOKING RD
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-2718
Mailing Address - Country:US
Mailing Address - Phone:301-537-5518
Mailing Address - Fax:703-288-0536
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:SUITE 208
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-722-6040
Practice Address - Fax:202-722-6042
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD041824207RN0300X
MA229874207R00000X
MDD0072850207RN0300X
VA0101248549207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1184779076Medicaid