Provider Demographics
NPI:1154440055
Name:DANESHVAR, CAROLINE (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:DANESHVAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:703-396-5292
Mailing Address - Fax:703-396-5297
Practice Address - Street 1:501 SUNSET LN
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3917
Practice Address - Country:US
Practice Address - Phone:703-396-5292
Practice Address - Fax:703-396-5297
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004886363AM0700X
VA0110005118363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1154440055Medicaid
VA1154440055Medicaid