MEDICARE: MR. IAN EDWIN DICK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0110004431	VA

General Provider Information

NPI Number	:	1003042268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IAN EDWIN DICK PA-C

Provider Business Mailing Address
First Line	:	PO BOX 791775
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21279-1775
Country	:	US
Telephone Number	:	571-302-5000
Fax Number	:	571-302-5001

Provider Business Practice Location Address
First Line	:	9404A MAIN ST
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4032
Country	:	US
Telephone Number	:	571-404-6974
Fax Number	:	571-604-6975

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	05/05/2026

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Directions to “ MR. IAN EDWIN DICK PA-C” Practice Location

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