Provider Demographics
NPI:1790088227
Name:SANGHA, ARCHANA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ARCHANA
Middle Name:
Last Name:SANGHA
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 1:2236C GALLOWS RD FL 2
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-5200
Mailing Address - Country:US
Mailing Address - Phone:703-827-7008
Mailing Address - Fax:
Practice Address - Street 1:2236C GALLOWS RD FL 2
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-5200
Practice Address - Country:US
Practice Address - Phone:703-827-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004594363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110004594OtherVA