Provider Demographics
NPI:1508946104
Name:MCANINLEY, MARC ANTHONY (PA)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:ANTHONY
Last Name:MCANINLEY
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Gender:M
Credentials:PA
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Mailing Address - Street 1:5320 PROVIDENCE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4122
Mailing Address - Country:US
Mailing Address - Phone:757-413-7900
Mailing Address - Fax:757-413-7901
Practice Address - Street 1:5320 PROVIDENCE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4122
Practice Address - Country:US
Practice Address - Phone:757-413-7900
Practice Address - Fax:757-413-7901
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-12-29
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Provider Licenses
StateLicense IDTaxonomies
NC102367363A00000X
VA0110001125363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant