Provider Demographics
NPI:1629054853
Name:LEWANDOWSKI, MAGDALENA A (PA)
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:A
Last Name:LEWANDOWSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5896 6TH ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-2538
Mailing Address - Country:US
Mailing Address - Phone:202-607-4645
Mailing Address - Fax:703-558-6910
Practice Address - Street 1:1701 N GEORGE MASON DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3610
Practice Address - Country:US
Practice Address - Phone:703-558-8641
Practice Address - Fax:703-558-6910
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030289363A00000X
VA1100001674363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC016699N649Medicare ID - Type Unspecified
Q01121Medicare UPIN