Provider Demographics
NPI:1760506463
Name:STIEGLITZ, AMANDA J (PA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:STIEGLITZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:J
Other - Last Name:SCOVIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:110 IRVING ST NW
Mailing Address - Street 2:ROOM 4B 42
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3017
Mailing Address - Country:US
Mailing Address - Phone:202-877-7462
Mailing Address - Fax:202-877-7258
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:ROOM 4B 42
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:202-877-7462
Practice Address - Fax:202-877-7258
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030540363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005909U92Medicare ID - Type Unspecified
VAQ29489Medicare UPIN