Healthcare Provider Details

I. General information

NPI: 1922230994
Provider Name (Legal Business Name): FRANK FORTIER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 HINSON FARM RD
ALEXANDRIA VA
22306-3403
US

IV. Provider business mailing address

8926 WOODYARD RD SUITE 701
CLINTON MD
20735-4220
US

V. Phone/Fax

Practice location:
  • Phone: 703-765-4321
  • Fax:
Mailing address:
  • Phone: 301-856-1682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110001280
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: