Individual
DAMON J LICARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
8081 INNOVATION PARK DR STE 602, FAIRFAX, VA 22031-4867
(571) 472-3270
(571) 472-3271
Mailing address
PO BOX 37174, BALTIMORE, MD 21297-3174
(571) 423-5699
(571) 423-5698
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001250
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP0624
—
SC
Enumeration date
08/24/2005
Last updated
03/15/2022
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