Provider Demographics
NPI:1891831657
Name:LOE, TIFFANY (PA)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:LOE
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 1:616 E ST NW
Mailing Address - Street 2:APT 622
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20004-2264
Mailing Address - Country:US
Mailing Address - Phone:585-269-4163
Mailing Address - Fax:
Practice Address - Street 1:8201 GREENSBORO DR
Practice Address - Street 2:SUITE 1003
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3810
Practice Address - Country:US
Practice Address - Phone:703-212-0700
Practice Address - Fax:703-212-0705
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003457363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110003457OtherLICENSE