Provider Demographics
NPI:1114496585
Name:TANNEY-PALMETER, JAMES (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:TANNEY-PALMETER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 MASSACHUSETTS AVE NW APT 334
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-5806
Mailing Address - Country:US
Mailing Address - Phone:202-841-8760
Mailing Address - Fax:
Practice Address - Street 1:6320 ROLLING ROAD
Practice Address - Street 2:J
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2326
Practice Address - Country:US
Practice Address - Phone:571-889-3235
Practice Address - Fax:571-889-3236
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0007052363A00000X
VA0110006480363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant