Healthcare Provider Details

I. General information

NPI: 1679345847
Provider Name (Legal Business Name): ABIGAIL COLEMAN TAYLOR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABIGAIL COLEMAN

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 04/23/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY
RESTON VA
20190-3204
US

IV. Provider business mailing address

4951 WESTCROFT BLVD APT 286
CHANTILLY VA
20151-1578
US

V. Phone/Fax

Practice location:
  • Phone: 703-689-9000
  • Fax:
Mailing address:
  • Phone: 570-335-7282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA200001734
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110009639
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: