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General NPI Number Information
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NPI Number | 1982335444
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Entity Type | Individual
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Provider Name | COLLEEN BURKHART PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 1886 METRO CENTER DR STE 650
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City | RESTON
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State | VA
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Zip | 20190-5294
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Country | US
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Telephone | 703-437-7744
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 16TH ST S APT 616
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City | ARLINGTON
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State | VA
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Zip | 22204-4951
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Country | US
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Telephone | 703-867-2138
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110007630
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License Number State | VA
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