Provider Demographics
NPI:1790853703
Name:PRICE, VALERIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
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 1:2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANCE UNT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:501 NORTH FREDERICK AVENUE
Practice Address - Street 2:
Practice Address - City:GALTHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2598
Practice Address - Country:US
Practice Address - Phone:301-258-7265
Practice Address - Fax:301-258-7253
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0000429364SN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SN0000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
004729M92Medicare ID - Type Unspecified
S96473Medicare UPIN