Provider Demographics
NPI:1982905048
Name:SIRACUSA, DENNIS ANTHONY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:ANTHONY
Last Name:SIRACUSA
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 1:3290 ABERFOYLE PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2356
Mailing Address - Country:US
Mailing Address - Phone:202-276-1699
Mailing Address - Fax:
Practice Address - Street 1:3290 ABERFOYLE PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2356
Practice Address - Country:US
Practice Address - Phone:202-276-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA30156363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA536208Medicare PIN