Provider Demographics
NPI:1376509109
Name:IPSARO, MAGGIE LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:LYNN
Last Name:IPSARO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:BLOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:BUILDING 1, SUITE 501
Mailing Address - City:BALITMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21031
Mailing Address - Country:US
Mailing Address - Phone:410-329-1071
Mailing Address - Fax:410-329-1054
Practice Address - Street 1:8501 ARLINGTON BLVD STE 410
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:703-738-4331
Practice Address - Fax:703-642-1876
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001753363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP45626Medicare UPIN