Provider Demographics
NPI:1447363379
Name:SOARES, DIONNE (PAC)
Entity type:Individual
Prefix:
First Name:DIONNE
Middle Name:
Last Name:SOARES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 VARNUM ST NE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2107
Mailing Address - Country:US
Mailing Address - Phone:202-269-7116
Mailing Address - Fax:202-269-7754
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:SUITE 216
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-269-7116
Practice Address - Fax:202-269-7754
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA30174363A00000X
MDC0002373363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical