Individual
TEDRIC LOLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1008 TAVERN RD STE 102, MARTINSBURG, WV 25401-2801
(304) 263-5129
(304) 263-3726
Mailing address
220 CAMPUS BLVD STE 210, WINCHESTER, VA 22601-2889
(540) 536-5100
(540) 536-0235
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
04/18/2022
Last updated
01/17/2023
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