Provider Demographics
NPI:1962787044
Name:OATES, BRITTANY LYNN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:LYNN
Last Name:OATES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:L
Other - Last Name:BANIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 75420
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-5420
Mailing Address - Country:US
Mailing Address - Phone:703-383-6469
Mailing Address - Fax:703-385-1062
Practice Address - Street 1:1850 TOWN CENTER PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3219
Practice Address - Country:US
Practice Address - Phone:703-810-5202
Practice Address - Fax:703-810-5420
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001349A363AS0400X
VA0110004202363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400058937Medicare PIN
IN0449980001Medicare NSC
538695Medicare PIN