Healthcare Provider Details

I. General information

NPI: 1457304065
Provider Name (Legal Business Name): CECILIA DUARTE ROSS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 BRANDON AVE STE 360
SPRINGFIELD VA
22150-2519
US

IV. Provider business mailing address

6225 BRANDON AVE STE 360
SPRINGFIELD VA
22150-2519
US

V. Phone/Fax

Practice location:
  • Phone: 703-202-9168
  • Fax: 703-202-9169
Mailing address:
  • Phone: 703-202-9168
  • Fax: 703-202-9169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110001838
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: