Physician Compare National (NPI:1770610289)

HEALTHCARE PROVIDER: SONIA J MABOUT PA-C

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1770610289
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6901939875
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180220001610
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MABOUT
	Individual professional last name
Provider First Name	SONIA
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	2004
	Individual professional's medical school graduation year
Primary Specialty	PHYSICIAN ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MODERN VASCULAR OF FAIRFAX LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	1052645355
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2812 OLD LEE HWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 100B
	Group Practice or individual's line 2 address
City	FAIRFAX
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	220314315
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5712796849
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y