Healthcare Provider Details

I. General information

NPI: 1598312662
Provider Name (Legal Business Name): ALYSSA DANIELLE RITNER PA-C, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 OLD MEADOW RD STE 220
MC LEAN VA
22102-4330
US

IV. Provider business mailing address

1760 OLD MEADOW RD STE 220
MC LEAN VA
22102-4330
US

V. Phone/Fax

Practice location:
  • Phone: 703-783-3529
  • Fax:
Mailing address:
  • Phone: 703-783-3529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0007254
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA031620
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110006772
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: