Provider Demographics
NPI:1235308040
Name:RICHARDSON, ABBI (PA-C)
Entity Type:Individual
Prefix:
First Name:ABBI
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ABBI
Other - Middle Name:
Other - Last Name:GARRINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8525 ROLLING RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-3673
Mailing Address - Country:US
Mailing Address - Phone:703-393-1667
Mailing Address - Fax:703-393-2517
Practice Address - Street 1:8525 ROLLING RD STE 300
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:703-393-1667
Practice Address - Fax:703-393-2517
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002733363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
538695Medicare PIN
VA193816ZARVMedicare PIN