Individual
MARY C TISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3580 JOSEPH SIEWICK DR STE 305, FAIRFAX, VA 22033-1764
(703) 648-3266
(703) 648-3264
Mailing address
2901 TELESTAR CT., #300, FALLS CHURCH, VA 22042-1263
(703) 591-1688
(703) 591-1445
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110003594
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558566445
—
VA
Enumeration date
06/19/2007
Last updated
08/27/2021
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