Provider Demographics
NPI:1922230994
Name:FORTIER, FRANK (PA-C)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:
Last Name:FORTIER
Suffix:
Gender:M
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 1:8926 WOODYARD RD
Mailing Address - Street 2:SUITE 701
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4220
Mailing Address - Country:US
Mailing Address - Phone:301-856-1682
Mailing Address - Fax:
Practice Address - Street 1:8101 HINSON FARM RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3403
Practice Address - Country:US
Practice Address - Phone:703-765-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001280363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1024354OtherNCCPA CERTIFICATION #
0110001280OtherVIRGINIA LICENSE
1024354OtherNCCPA CERTIFICATION #