Tisch, Mary C

Tisch, Mary C is an individual health care provider with primary practice located at 3580 Joseph Siewick Dr Ste 305 , Fairfax VA 22033-1764. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Tisch, Mary C can be contacted via phone (703) 648-3266.

Contact Information

Primary practice address
3580 Joseph Siewick Dr Ste 305 Fairfax VA 22033-1764
Phone: (703) 648-3266
Fax: (703) 648-3264
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 0110003594 Virginia

Profile Details

NPI number 1558566455
LBN Legal business name Tisch, Mary C
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 19th, 2007
Last updated Aug 27th, 2021 - about 3 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 1558566455 NPPES
Virginia MEDICAID 1558566445

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