Provider Demographics
NPI:1528095098
Name:STORER, DEAN JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:JAMES
Last Name:STORER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:44050-195 ASHBURN PLAZA
Mailing Address - Street 2:BOX 710
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147
Mailing Address - Country:US
Mailing Address - Phone:703-379-7215
Mailing Address - Fax:202-265-7804
Practice Address - Street 1:6000 STEVENSON AVE STE 208
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3526
Practice Address - Country:US
Practice Address - Phone:703-379-7215
Practice Address - Fax:202-265-7804
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-0451752084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007709889Medicaid
VAC89222Medicare UPIN
VA007709889Medicaid