Provider Demographics
NPI:1992814016
Name:DITARANTO, JAMES (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:DITARANTO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19500 SANDRIDGE WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3689
Mailing Address - Country:US
Mailing Address - Phone:703-840-7300
Mailing Address - Fax:703-840-7301
Practice Address - Street 1:19500 SANDRIDGE WAY STE 200
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3689
Practice Address - Country:US
Practice Address - Phone:703-840-7300
Practice Address - Fax:703-840-7301
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102049947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00W072A04Medicare ID - Type Unspecified
B33554Medicare UPIN