Healthcare Provider Details

I. General information

NPI: 1962787044
Provider Name (Legal Business Name): BRITTANY LYNN OATES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY L BANIC PA-C

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY SUITE 400
RESTON VA
20190-3219
US

IV. Provider business mailing address

PO BOX 75420
BALTIMORE MD
21275-5420
US

V. Phone/Fax

Practice location:
  • Phone: 703-810-5202
  • Fax: 703-810-5420
Mailing address:
  • Phone: 703-383-6469
  • Fax: 703-385-1062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number10001349A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110004202
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: