Provider Demographics
NPI:1679723605
Name:DOBSON, DONNA LIANNE (PA-C)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:LIANNE
Last Name:DOBSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:LIANNE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:15215 SHADY GROVE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3235
Mailing Address - Country:US
Mailing Address - Phone:757-873-1554
Mailing Address - Fax:757-873-3239
Practice Address - Street 1:15215 SHADY GROVE RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3235
Practice Address - Country:US
Practice Address - Phone:301-519-0902
Practice Address - Fax:301-519-0905
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0008661363AM0700X
VA0110002867363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110002867OtherSTATE MEDICAL LICENSE
TXTXB153292Medicare PIN
VA0110002867OtherSTATE MEDICAL LICENSE