Provider Demographics
NPI:1104169549
Name:WALKER, MARY ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:WALKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:GRIFFITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:19465 DEERFIELD AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1707
Mailing Address - Country:US
Mailing Address - Phone:703-858-1800
Mailing Address - Fax:703-858-1801
Practice Address - Street 1:19465 DEERFIELD AVE STE 405
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1707
Practice Address - Country:US
Practice Address - Phone:703-858-1800
Practice Address - Fax:703-858-1801
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC05036363A00000X
VA0110007139363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant