Provider Demographics
NPI:1982650685
Name:FORTI, SANDRA K (PAC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:K
Last Name:FORTI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1106 EMERALD DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308
Mailing Address - Country:US
Mailing Address - Phone:703-360-1159
Mailing Address - Fax:
Practice Address - Street 1:8600 OLD GEORGETOWN RD
Practice Address - Street 2:SUBURBAN ER
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:301-896-3880
Practice Address - Fax:301-897-1358
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001446363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P28965Medicare UPIN
VA008981E14Medicare ID - Type Unspecified