Provider Demographics
NPI:1548572589
Name:MOGHE, ANITA (PA-C)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:MOGHE
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 1:333 1ST ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-2661
Mailing Address - Country:US
Mailing Address - Phone:415-840-0560
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:2800 EISENHOWER AVE STE 220
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4587
Practice Address - Country:US
Practice Address - Phone:415-840-0560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02041363AM0700X
ORPA193360363AM0700X
VA0110007281363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH25519Medicare UPIN