Provider Demographics
NPI:1902009723
Name:JANISKO, THOMAS JAMES (MS, PA-C)
Entity Type:Individual
Prefix:PROF
First Name:THOMAS
Middle Name:JAMES
Last Name:JANISKO
Suffix:
Gender:M
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7023 HAYCOCK RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2315
Mailing Address - Country:US
Mailing Address - Phone:202-359-3847
Mailing Address - Fax:
Practice Address - Street 1:9501 FARRELL RD
Practice Address - Street 2:SUITE GC-11
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5901
Practice Address - Country:US
Practice Address - Phone:703-806-4526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1688363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant