Healthcare Provider Details

I. General information

NPI: 1154493658
Provider Name (Legal Business Name): LAUREN HEATHER VOGAN PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21785 FILIGREE COURT SUITE 201
ASHBURN VA
20147
US

IV. Provider business mailing address

8115 OLD DOMINION DR STE 220
MC LEAN VA
22102-2324
US

V. Phone/Fax

Practice location:
  • Phone: 703-726-9930
  • Fax: 703-723-8283
Mailing address:
  • Phone: 703-726-9930
  • Fax: 703-723-8283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110002297
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: