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NPI Code Detail

MEDICARE: DANIELLE WHITACRE PA-C

MEDICARE: DANIELLE WHITACRE 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
1363AM0700XMedical Physician Assistant
2363A00000XPhysician Assistant54934CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
154934OTHERCAPHYSICIAN ASSISTANT BOARD

General Provider Information

NPI Number : 1932610425
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE WHITACRE PA-C
Provider Business Mailing Address
First Line : 4141 W WILSON RD BLDG 1600
Second Line :
City : INDIAN HEAD
State : MD
Zip : 20640-5162
Country : US
Telephone Number : 301-744-4604
Fax Number :
Provider Business Practice Location Address
First Line : 4141 W WILSON RD BLDG 1600
Second Line :
City : INDIAN HEAD
State : MD
Zip : 20640-5162
Country : US
Telephone Number : 301-744-4604
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2017
Last Update Date : 07/11/2024

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Directions to “ DANIELLE WHITACRE PA-C” Practice Location

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