Provider Demographics
NPI:1669227591
Name:MACIAS, NOELY G (PA-C)
Entity type:Individual
Prefix:
First Name:NOELY
Middle Name:G
Last Name:MACIAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2922 TELESTAR CT
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1206
Mailing Address - Country:US
Mailing Address - Phone:703-584-2040
Mailing Address - Fax:703-560-7218
Practice Address - Street 1:2922 TELESTAR CT
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1206
Practice Address - Country:US
Practice Address - Phone:703-584-2040
Practice Address - Fax:703-560-7218
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110010074363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant