Provider Demographics
NPI:1376581645
Name:FITZGERALD, ANUSHAYA MISRA (PAC)
Entity Type:Individual
Prefix:
First Name:ANUSHAYA
Middle Name:MISRA
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ANOO
Other - Middle Name:SHAYA
Other - Last Name:MISRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 17334
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1334
Mailing Address - Country:US
Mailing Address - Phone:703-443-6717
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:224D CORNWALL ST NW
Practice Address - Street 2:SUITE 204
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2700
Practice Address - Country:US
Practice Address - Phone:703-777-3262
Practice Address - Fax:703-777-3365
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001287363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008955301Medicaid
VAC06319Medicare PIN
P84593Medicare UPIN
VA008955301Medicaid