Basic Information
| Provider Information | |||||||||
| NPI: | 1700866316 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BASS | ||||||||
| FirstName: | RITA | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2722 MERRILEE DR STE 230 | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036984483 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8926 WOODYARD RD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | CLINTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207354220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018563670 | ||||||||
| FaxNumber: | 3018680129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 04/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0101034430 | VA | N | Other Service Providers | Specialist | 2085R0202X | 0101034430 | VA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 174400000X | D27202 | MD | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 010292395 | 05 | VA | MEDICAID | 761600700 | 05 | MD | MEDICAID | 010331048 | 05 | VA | MEDICAID | 010292417 | 05 | VA | MEDICAID |