Provider Demographics
NPI:1154591543
Name:EMMONS, ANGELA M (PA-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:EMMONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:VEIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 CAMPUS BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2889
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:759 S MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1127
Practice Address - Country:US
Practice Address - Phone:540-459-1540
Practice Address - Fax:540-459-1486
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002693363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
54-1948807OtherTAX ID
VA017080B36OtherMEDICARE
VA1154591543Medicaid