Healthcare Provider Details

I. General information

NPI: 1023342227
Provider Name (Legal Business Name): JAMIE RATH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 ARMY PENTAGON
WASHINGTON DC
20310-5801
US

IV. Provider business mailing address

420 FLORIDA AVE NE # 230
WASHINGTON DC
20002-3438
US

V. Phone/Fax

Practice location:
  • Phone: 703-692-6131
  • Fax:
Mailing address:
  • Phone: 760-736-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number52440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: