Provider Demographics
NPI:1073819736
Name:BLAIR, CAITLIN GRETA (PA-C)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:GRETA
Last Name:BLAIR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:148 LINDEN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6902
Mailing Address - Country:US
Mailing Address - Phone:540-504-0075
Mailing Address - Fax:540-678-9025
Practice Address - Street 1:1867 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2801
Practice Address - Country:US
Practice Address - Phone:540-667-8724
Practice Address - Fax:540-723-0741
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2016-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110003524363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV0097AMedicare PIN
VAVV0097B566Medicare PIN