Individual
PHORNPHAN MOLTANE HOMIAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6035 BURKE CENTRE PKWY, SUITE 120, BURKE, VA 22015-3750
(703) 425-6010
(703) 425-7504
Mailing address
6035 BURKE CENTRE PKWY, SUITE 120, BURKE, VA 22015-3750
(703) 425-6010
(703) 425-7504
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110004437
VA
363A00000X
Physician Assistant
103810
NC
Other
Enumeration date
02/07/2008
Last updated
11/18/2014
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