Mack-Wilson, Larry C

Mack-Wilson, Larry C is an individual health care provider with primary practice located at 1850 Town Center Pkwy , Reston VA 20190-3219. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Mack-Wilson, Larry C can be contacted via phone (703) 689-9039.

Contact Information

Primary practice address
1850 Town Center Pkwy Reston VA 20190-3219
Phone: (703) 689-9039
Fax: (703) 689-9109
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 0110003693 Virginia

Profile Details

NPI number 1235413667
LBN Legal business name Mack-Wilson, Larry C
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 4th, 2011
Last updated Oct 4th, 2011 - about 13 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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