Healthcare Provider Details

I. General information

NPI: 1891960407
Provider Name (Legal Business Name): BARBARA L PARKINSON PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 SUNRISE VALLEY DR
RESTON VA
20191
US

IV. Provider business mailing address

PO BOX 713666
CINCINNATI OH
45271-4527
US

V. Phone/Fax

Practice location:
  • Phone: 703-709-1114
  • Fax: 703-709-1117
Mailing address:
  • Phone: 703-738-4339
  • Fax: 703-642-1876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA053299
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: