=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629100185
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOIRA HANLEY-NIEMAN PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2007
-----------------------------------------------------
Last Update Date | 03/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 GIBSON STREET, NW, SUITE 215
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20176-2115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-707-2085
-----------------------------------------------------
Fax | 571-291-9196
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 224-D CORNWALL STREET, NW, SUITE 403
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20176-2704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-737-6010
-----------------------------------------------------
Fax | 703-443-8643
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 0110003807
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------