Healthcare Provider Details

I. General information

NPI: 1578920211
Provider Name (Legal Business Name): MELISSA HOLBROOK WALKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21785 FILIGREE COURT, SUITE 101 RESTON RADIOLOGY CONSULTANTS
ASHBURN VA
20147
US

IV. Provider business mailing address

4108 POINT HOLLOW LN
FAIRFAX VA
22033-3012
US

V. Phone/Fax

Practice location:
  • Phone: 703-726-1201
  • Fax: 703-858-7150
Mailing address:
  • Phone: 703-798-6618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-005183
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: