Individual
CARLYLE FAIRFAX HOOFF CASELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
14010 SMOKETOWN RD, SUITE 117, WOODBRIDGE, VA 22192-4722
(703) 580-0181
Mailing address
14010 SMOKETOWN RD, SUITE 117, WOODBRIDGE, VA 22192-4722
(703) 580-0181
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110005347
VA
363A00000X
Physician Assistant
PA0000002616
TN
Other
Enumeration date
09/15/2010
Last updated
04/13/2017
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