Healthcare Provider Details

I. General information

NPI: 1942273594
Provider Name (Legal Business Name): CHRISTINE A COETZEE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8180 GREENSBORO DR STE 300
MC LEAN VA
22102-3888
US

IV. Provider business mailing address

PO BOX 75420
BALTIMORE MD
21275-5420
US

V. Phone/Fax

Practice location:
  • Phone: 703-810-5217
  • Fax: 703-810-5423
Mailing address:
  • Phone: 703-383-6469
  • Fax: 703-385-1062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9106613
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110003645
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: