Provider Demographics
NPI:1427832559
Name:ASSADI, NEGGIN (PA-C)
Entity type:Individual
Prefix:
First Name:NEGGIN
Middle Name:
Last Name:ASSADI
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 1:249 COMMONS DR NW
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4216
Mailing Address - Country:US
Mailing Address - Phone:703-508-7826
Mailing Address - Fax:
Practice Address - Street 1:19500 SANDRIDGE WAY, SUITE 420
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3697
Practice Address - Country:US
Practice Address - Phone:571-375-8601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110009377363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1427832559Medicaid
VA30017677960002Medicaid