Provider Demographics
NPI:1154349801
Name:MCDANIEL, TAMARA R (PA-C)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:R
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:G
Other - Last Name:RICHMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:801 N QUINCY ST STE 601
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1729
Mailing Address - Country:US
Mailing Address - Phone:703-812-4642
Mailing Address - Fax:703-812-7926
Practice Address - Street 1:172 LINDEN DR STE 100
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2892
Practice Address - Country:US
Practice Address - Phone:703-812-4642
Practice Address - Fax:703-812-7926
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01193363A00000X
VA0110002966363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA27232Medicare PIN