Provider Demographics
NPI:1851923916
Name:WHITTEMORE, RACHAEL MCKINNON (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:MCKINNON
Last Name:WHITTEMORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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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:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:400 CAMPUS BLVD STE 210
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6906
Practice Address - Country:US
Practice Address - Phone:540-536-3470
Practice Address - Fax:540-536-3471
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-007640363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110-007640OtherVIRGINIA MEDICAL LICENSE
1180885OtherNCCPA ID