Provider Demographics
NPI:1255682589
Name:ISELIN, TINSLEY SIMONDS (PA-C)
Entity Type:Individual
Prefix:
First Name:TINSLEY
Middle Name:SIMONDS
Last Name:ISELIN
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 1:8926 WOODYARD RD
Mailing Address - Street 2:SUITE 701
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4220
Mailing Address - Country:US
Mailing Address - Phone:301-856-1682
Mailing Address - Fax:301-856-0964
Practice Address - Street 1:8926 WOODYARD RD
Practice Address - Street 2:SUITE 701
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4220
Practice Address - Country:US
Practice Address - Phone:301-856-1682
Practice Address - Fax:301-856-0964
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004858363A00000X
VA0110004018363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
C0004858OtherMARYLAND LICENSE
0110004018OtherVIRGINIA LICENSE