Healthcare Provider Details

I. General information

NPI: 1568440329
Provider Name (Legal Business Name): ROBIN LYNNE VESTAL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

9304 CROSS TIMBERS CT
LAUREL MD
20723-1756
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8000
  • Fax: 202-745-8184
Mailing address:
  • Phone: 301-362-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110001568
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: