Individual
MR. JOSHUA RYAN DETRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6355 WALKER LANE, STE 202, ALEXANDRIA, VA 22310-3257
(703) 810-5210
(703) 810-5418
Mailing address
PO BOX 75420, BALTIMORE, MD 21275-5420
(703) 383-6469
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-01389
NC
363A00000X
Physician Assistant
Primary
0110003713
VA
Other
Enumeration date
06/18/2008
Last updated
07/06/2015
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