Provider Demographics
NPI:1205069663
Name:MACZEES, LAURA E (PA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:MACZEES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:E
Other - Last Name:NIGRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 75420
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-5420
Mailing Address - Country:US
Mailing Address - Phone:703-383-6469
Mailing Address - Fax:
Practice Address - Street 1:1635 N GEORGE MASON DR
Practice Address - Street 2:STE 310
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3616
Practice Address - Country:US
Practice Address - Phone:703-810-5215
Practice Address - Fax:703-810-5428
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003088363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA165044ZARVMedicare PIN
538695Medicare PIN