Healthcare Provider Details

I. General information

NPI: 1629893003
Provider Name (Legal Business Name): ALYSSA A GLAVINOS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-2274
  • Fax: 703-776-3572
Mailing address:
  • Phone: 703-776-2274
  • Fax: 703-776-3572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011622
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: