MEDICARE: PATRICK MATHENY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	110840150	VA

General Provider Information

NPI Number	:	1073534814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK MATHENY PA-C

Provider Business Mailing Address
First Line	:	PO BOX 71230
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19176-6230
Country	:	US
Telephone Number	:	703-383-6469
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 JOSEPH SIEWICK DR
Second Line	:	STE 100
City	:	FAIRFAX
State	:	VA
Zip	:	22033-1757
Country	:	US
Telephone Number	:	703-810-5223
Fax Number	:	703-810-5403

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/26/2013

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Directions to “ PATRICK MATHENY PA-C” Practice Location

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