Basic Information
| Provider Information | |||||||||
| NPI: | 1962695403 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACCUBBIN | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | WALKER | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2445 ARMY NAVY DR | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222062905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037698431 | ||||||||
| FaxNumber: | 7037698437 | ||||||||
| Practice Location | |||||||||
| Address1: | 2445 ARMY NAVY DR | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222062905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037698431 | ||||||||
| FaxNumber: | 7037698437 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2007 | ||||||||
| LastUpdateDate: | 05/06/2011 | ||||||||
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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 | 363AM0700X | 0110002577 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.