Provider Demographics
NPI:1497888697
Name:BANFORD, LUCRISHA M (PA)
Entity Type:Individual
Prefix:MISS
First Name:LUCRISHA
Middle Name:M
Last Name:BANFORD
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3700 JOSEPH SIEWICK DR
Mailing Address - Street 2:SUITE 403
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1744
Mailing Address - Country:US
Mailing Address - Phone:703-648-2488
Mailing Address - Fax:703-648-2489
Practice Address - Street 1:3700 JOSEPH SIEWICK DR
Practice Address - Street 2:SUITE 403
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1744
Practice Address - Country:US
Practice Address - Phone:703-648-2488
Practice Address - Fax:703-648-2489
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2011-05-20
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Provider Licenses
StateLicense IDTaxonomies
VA0110002011363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1497888697OtherNPI