Provider Demographics
NPI:1477570182
Name:BOAN, TIMOTHY CAPERS (PA-C)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CAPERS
Last Name:BOAN
Suffix:
Gender:M
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 1:12410 MILESTONE CENTER DR
Mailing Address - Street 2:MEDICAL EMERGENCY PROFESSIONALS, SUITE 225
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-7101
Mailing Address - Country:US
Mailing Address - Phone:866-828-1780
Mailing Address - Fax:
Practice Address - Street 1:8700 SUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4418
Practice Address - Country:US
Practice Address - Phone:866-828-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001834363A00000X
MDC0002904363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q19437Medicare UPIN
VA008325E54Medicare ID - Type Unspecified