Individual
MEREDITH H WOTKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1635 N GEORGE MASON DR, ARLINGTON, VA 22205-3601
(703) 524-1212
Mailing address
1635 N GEORGE MASON DR, ARLINGTON, VA 22205-3601
(035) 241-2127
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110006784
VA
363A00000X
Physician Assistant
1260
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020484-1
STATE PHYSICIAN ASSISTANT LICENSE
NY
01
—
085.0006096
STATE PHYSICIAN ASSISTANT LICENSE
IL
01
—
1260
STATE LICENSE NUMBER
NE
01
—
6628
STATE PHYSICIAN ASSISTANT LICENSE
AZ
01
—
PA031320
STATE PHYSICIAN ASSISTANT LICENSE
DC
01
—
PA54114
STATE PHYSICIAN ASSISTANT LICENSE
CA
01
—
PA6026
STATE PHYSICIAN ASSISTANT LICENSE
MA
Enumeration date
04/24/2007
Last updated
01/15/2020
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