Provider Demographics
NPI:1174502744
Name:LONGSTRETH, TARYN CHRISTINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TARYN
Middle Name:CHRISTINE
Last Name:LONGSTRETH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:TARYN
Other - Middle Name:CHRISTINE
Other - Last Name:GETTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1101 OPAL CT
Mailing Address - Street 2:VA OUTPATIENT CLINIC
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5941
Mailing Address - Country:US
Mailing Address - Phone:301-665-1462
Mailing Address - Fax:301-665-1682
Practice Address - Street 1:1101 OPAL CT
Practice Address - Street 2:VA OUTPATIENT CLINIC
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5941
Practice Address - Country:US
Practice Address - Phone:301-665-1462
Practice Address - Fax:301-665-1682
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050670363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical