Basic Information
| Provider Information | |||||||||
| NPI: | 1558546242 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAHVILDARY | ||||||||
| FirstName: | ATOSSA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | WRNMMC 8901 WISCONSIN AVE | ||||||||
| Address2: | WALTER REED ARMY MEDICAL CENTER ATN: MCHL-MAO-C | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208890001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012957850 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6900 GEORGIA AVE NW | ||||||||
| Address2: | WALTER REED ARMY MEDICAL CENTER ATN: MCHL-MAO-C | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 203070003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027827341 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/01/2008 | ||||||||
| LastUpdateDate: | 03/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | C0003442 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.