Provider Demographics
NPI:1235164641
Name:GITTINGS, MICHELE SUZAN (PA C)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:SUZAN
Last Name:GITTINGS
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:SUZAN
Other - Last Name:KOVALCIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA C
Mailing Address - Street 1:PO BOX 13700
Mailing Address - Street 2:COMMONWEALTH EMERGENCY PHYSICIANS PC
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19191-0001
Mailing Address - Country:US
Mailing Address - Phone:800-777-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:44045 RIVERSIDE PKWY
Practice Address - Street 2:LOUDOUN HOSPITAL CENTER
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5101
Practice Address - Country:US
Practice Address - Phone:703-858-6044
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110 001865363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q19105Medicare UPIN
VA010123C77Medicare ID - Type Unspecified