Healthcare Provider Details

I. General information

NPI: 1538431523
Provider Name (Legal Business Name): MVP ASSISTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 06/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35731 DUNTHORPE LN
PURCELLVILLE VA
20132-5225
US

IV. Provider business mailing address

35731 DUNTHORPE LN
PURCELLVILLE VA
20132-5225
US

V. Phone/Fax

Practice location:
  • Phone: 540-668-6350
  • Fax: 540-668-6350
Mailing address:
  • Phone: 703-395-3885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110001565
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MS. POLLY ANN PORTER
Title or Position: PRESIDENT
Credential: PA-C
Phone: 703-395-3885