Healthcare Provider Details

I. General information

NPI: 1902109127
Provider Name (Legal Business Name): JOY ANNE ROSTRON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS ROAD
FALLS CHURCH VA
22042-3300
US

IV. Provider business mailing address

3300 GALLOWS ROAD
FALLS CHURCH VA
22042-3300
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-8310
  • Fax: 703-776-4018
Mailing address:
  • Phone: 703-776-8310
  • Fax: 703-776-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110003438
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110003438
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: