Healthcare Provider Details

I. General information

NPI: 1699987032
Provider Name (Legal Business Name): ELLEN M TOMICA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 23RD ST NW FL 5
WASHINGTON DC
20037-2342
US

IV. Provider business mailing address

61 P ST NW
WASHINGTON DC
20001-1133
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-4000
  • Fax:
Mailing address:
  • Phone: 248-444-0858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA030463
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: