Provider Demographics
NPI:1225115033
Name:BELLIARD, TANYA C (PA)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:C
Last Name:BELLIARD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:C
Other - Last Name:BELLIARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:14416 JEFFERSON DAVIS HWY
Mailing Address - Street 2:20
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-2801
Mailing Address - Country:US
Mailing Address - Phone:703-490-8200
Mailing Address - Fax:703-490-8225
Practice Address - Street 1:14416 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-2801
Practice Address - Country:US
Practice Address - Phone:703-490-8200
Practice Address - Fax:703-490-8225
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC030442363A00000X
VA0101057543363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant