Provider Demographics
NPI:1992732143
Name:MEDOFF, NEIL F (MD)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:F
Last Name:MEDOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11357 SUNSET HILLS RD
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190
Mailing Address - Country:US
Mailing Address - Phone:703-435-5858
Mailing Address - Fax:703-435-5877
Practice Address - Street 1:11357 SUNSET HILLS RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-435-5858
Practice Address - Fax:703-435-5877
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010121614207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6052622Medicaid
VA409107Medicare PIN
VA6052622Medicaid