Provider Demographics
NPI:1962695403
Name:MACCUBBIN, SARAH WALKER (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:WALKER
Last Name:MACCUBBIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2445 ARMY NAVY DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2905
Mailing Address - Country:US
Mailing Address - Phone:703-769-8431
Mailing Address - Fax:703-769-8437
Practice Address - Street 1:2445 ARMY NAVY DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2905
Practice Address - Country:US
Practice Address - Phone:703-769-8431
Practice Address - Fax:703-769-8437
Is Sole Proprietor?:No
Enumeration Date:2007-08-18
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110002577363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical