Provider Demographics
NPI:1437841954
Name:MAI, GINA (PA-C)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:MAI
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 1:6907 VILLA DEL REY CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-3064
Mailing Address - Country:US
Mailing Address - Phone:703-901-5852
Mailing Address - Fax:
Practice Address - Street 1:6907 VILLA DEL REY CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-3064
Practice Address - Country:US
Practice Address - Phone:703-901-5852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1208968363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant