Healthcare Provider Details

I. General information

NPI: 1508986100
Provider Name (Legal Business Name): MONICA BUZZETTA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 WOODBURN RD SUITE 107
ANNANDALE VA
22003-1229
US

IV. Provider business mailing address

716B NORFOLK LN
ALEXANDRIA VA
22314-6205
US

V. Phone/Fax

Practice location:
  • Phone: 703-876-0437
  • Fax: 703-876-0722
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110001970
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: