Basic Information
| Provider Information | |||||||||
| NPI: | 1730479379 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEPASQUALE | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 FEDERAL ST | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245042306 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 320 FEDERAL ST | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245042306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4344552480 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2011 | ||||||||
| LastUpdateDate: | 09/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD179159 | OR | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD040975 | DC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | S-5879 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0101252495 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.