Provider Demographics
NPI:1285062307
Name:ATHEY, GILLIAN W (PA-C)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:W
Last Name:ATHEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15245 SHADY GROVE RD STE 480
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6243
Mailing Address - Country:US
Mailing Address - Phone:301-264-5958
Mailing Address - Fax:
Practice Address - Street 1:15245 SHADY GROVE RD STE 480
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6243
Practice Address - Country:US
Practice Address - Phone:301-264-5958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030995363A00000X
VA0110005058363A00000X
MDC0005869363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant