Healthcare Provider Details

I. General information

NPI: 1154349801
Provider Name (Legal Business Name): TAMARA R MCDANIEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMARA G RICHMOND PA-C

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 LINDEN DR STE 100
WINCHESTER VA
22601-2892
US

IV. Provider business mailing address

801 N QUINCY ST STE 601
ARLINGTON VA
22203-1729
US

V. Phone/Fax

Practice location:
  • Phone: 703-812-4642
  • Fax: 703-812-7926
Mailing address:
  • Phone: 703-812-4642
  • Fax: 703-812-7926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number01193
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110002966
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: