DOMENIC DEROBERTIS (NPI# 1023545530) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023545530 |
| Entity Type | Individual |
| Full Name | DOMENIC DEROBERTIS |
| Credential | CAA |
| Practice Address |
1150 Varnum St Ne Washington DC 20017-2104 |
| Mailing Address |
13661 Samhill Ln Mount Airy MD 21771-4578 |
| Practice Telephone | 2028547000 |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2017-05-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367H00000X | Anesthesiologist Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1150 VARNUM ST NE |
| City | WASHINGTON |
| State | DC |
| Zip Code | 20017-2104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386648657 | Heather J Wayco | Dietitian, Registered | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2005-06-02 |
| 1508406653 | Pamela Fru Tange Oriaifo | Nurse Practitioner | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2020-01-07 |
| 1952946824 | Amarachi Angelina Nnamdi-eze | Physical Therapy Assistant | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2019-11-14 |
| 1598313595 | Providence Health Services, Inc | Clinic/Center | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2019-09-03 |
| 1861057416 | Providence Hospital | Clinic/Center | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2019-05-08 |
| 1861954638 | Providence Hospital | Emergency Medicine | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2019-04-02 |
| 1457837619 | Daniel Fernandez | Internal Medicine | 1150 Varnum St Ne, Washington, DC 20017 | 2018-07-11 |
| 1104311018 | Iman Fatima Musah | Anesthesiologist Assistant | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2018-06-25 |
| 1164923348 | Joy R Hudson | Social Worker | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2018-02-23 |
| 1740795293 | Providence Health Services, Inc | Nurse Anesthetist, Certified Registered | 1150 Varnum St Ne, Washington, DC 20017-2104 | 2017-12-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588215479 | Janet Achankeng Folem | Psychologist | 7100 Varnum St Ne, Suit 218, Washington, DC 20017 | 2019-09-23 |
| 1013475284 | Raphaelia Agnes Johnson-phillips | Technician | 440 Taylor St. Ne Building B Apt 22, Washington Dc, DC 20017 | 2019-03-06 |
| 1528551413 | Harpreet Saluja | Student in an Organized Health Care Education/Training Program | 1150 Varnum St Ne, Providence Hospital Im Department, Washington, DC 20017 | 2018-06-14 |
| 1134638042 | Jane Hayashi-kim | Speech-Language Pathologist | 3910 9th St Ne, Apartment 3, Washington, DC 20017 | 2017-09-22 |
| 1346766102 | Aaliyah Gabrielle Jones | Technician | 611edgewood Ne, Washington, DC 20017 | 2017-08-14 |
| 1417479197 | Javalin Singh | Home Health Aide | Hsc Pediatric Center 1731 Bunker Hill Rd, Washington, DC 20017 | 2017-07-13 |
| 1386174175 | Genevieve Wells | Home Health Aide | 601 Edgewood St. Ne, Apt 706, Washington, DC 20017 | 2017-06-14 |
| 1487183810 | Valerie Anne Pierre | Student in an Organized Health Care Education/Training Program | 1150 Varnum Street, N.e., Acc 209, Washington, DC 20017 | 2017-06-08 |
| 1639600984 | Liliana Tatum | Counselor | 1428 Hamlin Street Ne, Washington, DC 20017 | 2017-03-27 |
| 1750835435 | Marie Hortense Mabou Sando | Home Health Aide | 1416 9th Street Nwdc, Washington, DC 20017 | 2016-08-10 |
| Find all providers in zip 20017 | ||||
| Taxonomy Code | 367H00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Anesthesiologist Assistant |
| An individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants are required to have a bachelor's degree with a premed curriculum prior to entering a two-year anesthesiology assistant program, which is focused upon the delivery and maintenance of anesthesia care as well as advanced patient monitoring techniques. An Anesthesiologist Assistant must work as a member of the anesthesia care team under the direction of a qualified Anesthesiologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972136174 | Samuel Patrick Lind | Anesthesiologist Assistant | 2150 Pennsylvania Ave Nw Ste 10-407, Washington, DC 20037-3201 | 2020-02-16 |
| 1871059584 | Nancy Long | Anesthesiologist Assistant | 250 K St Ne Apt 606, Washington, DC 20002-8218 | 2019-02-18 |
| 1639653132 | Michael Diskin | Anesthesiologist Assistant | 110 Irving St Nw Ste G226, Washington, DC 20010-3017 | 2018-09-20 |
| 1346777273 | Ashleigh Dechow | Anesthesiologist Assistant | 110 Irving St Nw # G226, Washington, DC 20010-3017 | 2017-05-23 |
| 1659824738 | Kaitlin Jurcisin | Anesthesiologist Assistant | 1331 4th St Se Apt 1016, Washington, DC 20003-4479 | 2016-07-26 |
| 1801349956 | Jorjetta Ilieva | Anesthesiologist Assistant | 3401 38th St Nw, Apt 323, Washington, DC 20016-3037 | 2016-07-25 |
| 1821444373 | Jeffrey Bender | Anesthesiologist Assistant | 1150 Varnum St Ne Dept Of, Washington, DC 20017-2180 | 2016-05-13 |
| 1083223598 | Michael Mangiapani | Anesthesiologist Assistant | 900 23rd St Nw, Washington, DC 20037-2342 | 2020-07-30 |
| 1164043535 | Connor Conti | Anesthesiologist Assistant | 110 Irving St Nw, Washington, DC 20010-3017 | 2020-04-27 |
| 1306475348 | Josiah Mcfarland | Anesthesiologist Assistant | 110 Irving St Nw, Washington, DC 20010-3017 | 2020-04-02 |
| Find all providers in WASHINGTON | ||||
| City | WASHINGTON |
| Zip Code | 20017 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.