Individual
EILEEN C. DEARTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1215 LEE ST FL 2, CHARLOTTESVILLE, VA 22908-0001
(434) 243-6628
(434) 244-7588
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
0110004499
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538584057
—
VA
Enumeration date
02/20/2014
Last updated
08/25/2016
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