Provider Demographics
NPI:1396082954
Name:NADER, ELIZA COLEMAN (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:COLEMAN
Last Name:NADER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELIZA
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:301 CONCOURSE BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5759
Mailing Address - Country:US
Mailing Address - Phone:804-549-4040
Mailing Address - Fax:804-549-4032
Practice Address - Street 1:5421 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2003
Practice Address - Country:US
Practice Address - Phone:804-549-4040
Practice Address - Fax:804-285-2799
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22688363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant