MEDICARE: AMY BECKWITH REMBOLD 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	0110003231	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00110003231	OTHER	VA	VA LICENSE

General Provider Information

NPI Number	:	1902137193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY BECKWITH REMBOLD PA-C

Provider Business Mailing Address
First Line	:	224-D CORNWALL STREET, NW, SUITE 403
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20176-2704
Country	:	US
Telephone Number	:	703-737-6010
Fax Number	:	703-443-8643

Provider Business Practice Location Address
First Line	:	24430 STONE SPRINGS BLVD., SUITE 550
Second Line	:
City	:	DULLES
State	:	VA
Zip	:	20166-2269
Country	:	US
Telephone Number	:	571-957-1245
Fax Number	:	36-652-3747

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

Provider Enumeration Date	:	01/27/2010
Last Update Date	:	03/07/2024

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