Provider Demographics
NPI:1558546242
Name:TAHVILDARY, ATOSSA E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ATOSSA
Middle Name:E
Last Name:TAHVILDARY
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:WRNMMC 8901 WISCONSIN AVE
Mailing Address - Street 2:WALTER REED ARMY MEDICAL CENTER ATN: MCHL-MAO-C
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-0001
Mailing Address - Country:US
Mailing Address - Phone:301-295-7850
Mailing Address - Fax:
Practice Address - Street 1:6900 GEORGIA AVE NW
Practice Address - Street 2:WALTER REED ARMY MEDICAL CENTER ATN: MCHL-MAO-C
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0003
Practice Address - Country:US
Practice Address - Phone:202-782-7341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-01
Last Update Date:2017-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC0003442363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant