Stephanie Petruzzo

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110-007018 Issued in VA

Practice address

19450 Deerfield Avenue, Suite 325
Leesburg, VA 20176-8503

Phone

(571) 252-8119

Fax

(800) 735-1643

NPI assigned

May 2, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in DC, VA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Privia Medical Group, LLC

  • Internal Medicine Physician
  • Arlington, VA
  • NPI 1013042480

  DC

  Medicare reassignment NPD
• Fair Oaks Imaging Center, PC

  • Diagnostic Radiology Physician
  • Fairfax, VA
  • NPI 1063437903

  DC

  Medicare reassignment
• Loudoun Imaging Center/Ashburn, LLC

  • Radiology Clinic/Center
  • Ashburn, VA
  • NPI 1568615094
  Medicare reassignment
• Loudoun Medical Group, PC

  • Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
  • Reston, VA
  • NPI 1407908817

  DC

  Medicare reassignment
• MRI of Reston, LP

  • Diagnostic Radiology Physician
  • Reston, VA
  • NPI 1164447025

  DC

  Medicare reassignment
• Pet of Reston, LP

  • Diagnostic Radiology Physician
  • Reston, VA
  • NPI 1922024041

  DC

  Medicare reassignment
• Reston Radiology Consultants, PC

  • Diagnostic Radiology Physician
  • Reston, VA
  • NPI 1235307034

  DC

  Medicare reassignment
• Privia Medical Group, LLC

  • Pain Medicine (Psychiatry & Neurology) Physician
  • Rockville, MD
  • NPI 1811715436
  NPD
• Prince William Dermatology, P.C.

  • Specialist
  • Gainesville, VA
  • NPI 1508046293
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1093370348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224-D CORNWALL ST., NW",
            "address_2": "SUITE 403",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201762704",
            "telephone_number": "703-737-6010",
            "fax_number": "703-443-8643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19450 DEERFIELD AVENUE, SUITE 325",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201768503",
            "telephone_number": "571-252-8119",
            "fax_number": "800-735-1643"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10888 Woodleaf Ln",
            "address_purpose": "LOCATION",
            "city": "Great Falls",
            "state": "VA",
            "postal_code": "220663004",
            "country_code": "US",
            "telephone_number": "703-463-6023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRUZZO",
        "first_name": "STEPHANIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-02",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110-007018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30016029480002",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093370348",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carina Peter
• Brooke Ann Peters, LPC
• Caterina Gettier Peterson
• Genevieve Petraglia, NP
• Michelle L.F. Petruzzello, LPC
• Barbara E Petty, NP
• Alejandro H Pezo, LPC, QMHP-A
• Amber Nicole Pham, PHYSICIAN ASSISTANT
• Kevin Khang Pham
• Loan Ngoc Pham

• Physician Assistant in Leesburg, VA
• Providers in Leesburg, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.