Licari, Damon J

Licari, Damon J is an individual health care provider with primary practice located at 8081 Innovation Park Dr Ste 602 , Fairfax VA 22031-4867. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Licari, Damon J can be contacted via phone (571) 472-3270.

Contact Information

Primary practice address
8081 Innovation Park Dr Ste 602 Fairfax VA 22031-4867
Phone: (571) 472-3270
Fax: (571) 472-3271
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 0110001250 Virginia

Profile Details

NPI number 1962495069
LBN Legal business name Licari, Damon J
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 24th, 2005
Last updated Mar 15th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962495069 NPPES
South Carolina MEDICAID GP0624

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