MEDICARE: HANNAH MADISON HOWARD 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	363AS0400X	Surgical Physician Assistant	0110-006769	VA

General Provider Information

NPI Number	:	1699327932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH MADISON HOWARD PA-C

Provider Business Mailing Address
First Line	:	PO BOX 75868
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21275-5868
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 BALLENGER AVE # 200
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-6818
Country	:	US
Telephone Number	:	703-810-5209
Fax Number	:	703-810-5414

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

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	01/08/2022

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