Provider Demographics
NPI:1619607165
Name:LAHART, MAKAYLEA (PA-C)
Entity Type:Individual
Prefix:
First Name:MAKAYLEA
Middle Name:
Last Name:LAHART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MAKAYLEA
Other - Middle Name:
Other - Last Name:VICARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:220 CAMPUS BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2889
Mailing Address - Country:US
Mailing Address - Phone:540-459-1310
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:212 LINDEN DR STE 152
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2893
Practice Address - Country:US
Practice Address - Phone:540-667-0744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
VA0110008732363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant