Provider Demographics
NPI:1477690832
Name:FIRTH, LINDA DIANE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:DIANE
Last Name:FIRTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:DIANE
Other - Last Name:FERRARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5510 ALMA LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-4027
Mailing Address - Country:US
Mailing Address - Phone:703-642-5990
Mailing Address - Fax:703-642-2608
Practice Address - Street 1:513 W BROAD ST STE 100
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3257
Practice Address - Country:US
Practice Address - Phone:703-940-0000
Practice Address - Fax:703-533-0321
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840248363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant