Healthcare Provider Details

I. General information

NPI: 1396707444
Provider Name (Legal Business Name): TINA M C REMILLARD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 14TH ST NW
WASHINGTON DC
20009-4308
US

IV. Provider business mailing address

705 DALE DR
SILVER SPRING MD
20910-4217
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-6171
  • Fax: 202-745-0238
Mailing address:
  • Phone: 301-920-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA030346
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011002084
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC03002
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: