MEDICARE: GRACE ELIZABETH MCCONVILLE 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	363A00000X	Physician Assistant	0110007049	VA

General Provider Information

NPI Number	:	1578193025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE ELIZABETH MCCONVILLE PA-C

Provider Business Mailing Address
First Line	:	8101 HINSON FARM RD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-3403
Country	:	US
Telephone Number	:	703-780-9014
Fax Number	:	703-780-9077

Provider Business Practice Location Address
First Line	:	8101 HINSON FARM RD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-3403
Country	:	US
Telephone Number	:	703-780-9014
Fax Number	:	703-780-9077

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

Provider Enumeration Date	:	01/23/2020
Last Update Date	:	04/07/2026

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