=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891831657
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIFFANY LOE PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2007
-----------------------------------------------------
Last Update Date | 07/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8201 GREENSBORO DR SUITE 1003
-----------------------------------------------------
City | MC LEAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22102-3810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-212-0700
-----------------------------------------------------
Fax | 703-212-0705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 616 E ST NW APT 622
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20004-2264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-269-4163
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 0110003457
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------