Healthcare Provider Details

I. General information

NPI: 1366594962
Provider Name (Legal Business Name): DIANA DEWOLFE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 03/07/2023
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 N. GEORGE MASON DRIVE SUITE 150
ARLINGTON VA
22205
US

IV. Provider business mailing address

1635 N GEORGE MASON DR STE 150
ARLINGTON VA
22205-3679
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-6162
  • Fax: 301-694-8525
Mailing address:
  • Phone: 301-663-6162
  • Fax: 301-694-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110002675
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: