Individual
MR. MATTHEW ALLEN CISSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-8711
Mailing address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-8711
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1102319
CT
363AS0400X
Surgical Physician Assistant
0110-004585
VA
363AS0400X
Surgical Physician Assistant
C0004795
MD
Other
Enumeration date
09/29/2011
Last updated
01/30/2015
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