Basic Information
| Provider Information | |||||||||
| NPI: | 1184791725 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEROO | ||||||||
| FirstName: | ALTA | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 291943 | ||||||||
| Address2: | 525 ROYAL PARKWAY | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372291943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8339530829 | ||||||||
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| Practice Location | |||||||||
| Address1: | 767 MADISON RD STE 107 | ||||||||
| Address2: | |||||||||
| City: | CULPEPER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032145825 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 06/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 0101237764 | VA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207RA0401X | 2015108 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine |
No ID Information.