Provider Demographics
NPI:1124090915
Name:ORRELL, BETH (NP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:ORRELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5317
Mailing Address - Country:US
Mailing Address - Phone:703-532-2258
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-451-6882
Practice Address - Fax:443-537-9913
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN50060363L00000X, 207PH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC407666400Medicaid
DC010166161Medicaid
DC036088200Medicaid
DCI30680Medicare UPIN
DC017192W91Medicare ID - Type UnspecifiedMEDICARE
DC010227577Medicare ID - Type Unspecified010227577