Healthcare Provider Details

I. General information

NPI: 1174922645
Provider Name (Legal Business Name): MARIA ZUMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 ARMY PENTAGON
WASHINGTON DC
20310
US

IV. Provider business mailing address

5801 ARMY PENTAGON
WASHINGTON DC
20310-5801
US

V. Phone/Fax

Practice location:
  • Phone: 703-692-8860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-004698
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0005474
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA031071
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: