Provider Demographics
NPI:1578669610
Name:LOGA, GILDA (PA-C)
Entity Type:Individual
Prefix:
First Name:GILDA
Middle Name:
Last Name:LOGA
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 1:6211 CENTREVILLE RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2641
Mailing Address - Country:US
Mailing Address - Phone:703-222-0002
Mailing Address - Fax:703-449-9890
Practice Address - Street 1:6211 CENTREVILLE RD
Practice Address - Street 2:SUITE 700
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2641
Practice Address - Country:US
Practice Address - Phone:703-222-0002
Practice Address - Fax:703-449-9890
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002189363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q42415Medicare UPIN