Healthcare Provider Details

I. General information

NPI: 1073225058
Provider Name (Legal Business Name): MARYJEAN RICHNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 OLD CHAIN BRIDGE RD STE 101
MC LEAN VA
22101-3909
US

IV. Provider business mailing address

1340 OLD CHAIN BRIDGE RD STE 101
MC LEAN VA
22101-3909
US

V. Phone/Fax

Practice location:
  • Phone: 703-893-2273
  • Fax: 703-893-4559
Mailing address:
  • Phone: 703-893-2273
  • Fax: 703-893-4559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011634
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: