Healthcare Provider Details

I. General information

NPI: 1053794115
Provider Name (Legal Business Name): DANA WIGHTMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CONNECTICUT AVE NW STE 500
WASHINGTON DC
20036-5304
US

IV. Provider business mailing address

1050 CONNECTICUT AVE NW STE 500
WASHINGTON DC
20036-5304
US

V. Phone/Fax

Practice location:
  • Phone: 202-596-8891
  • Fax: 304-245-6029
Mailing address:
  • Phone: 202-596-8891
  • Fax: 304-245-6029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA200001388
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: