Provider Demographics
NPI:1598322406
Name:GREER, AGATA ALICJA (PA)
Entity Type:Individual
Prefix:
First Name:AGATA
Middle Name:ALICJA
Last Name:GREER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AGATA
Other - Middle Name:
Other - Last Name:KOWALSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:8802 STEWART ST
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3655
Mailing Address - Country:US
Mailing Address - Phone:703-408-5315
Mailing Address - Fax:
Practice Address - Street 1:1860 TOWN CENTER DR STE 240
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5899
Practice Address - Country:US
Practice Address - Phone:703-796-1986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-26
Last Update Date:2019-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-006656363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical