Active NPI
Abigail Yvonne Runyans, PA-C
- Physician Assistant
- Woodbridge, VA
National Provider Identifier
1578078697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0110005887
- Practice address
- 14605 Potomac Branch Dr Ste 100
Woodbridge, VA 22191-3337 - Phone
- (703) 738-4371
- Fax
- (703) 642-1876
- NPI assigned
- Dec 12, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110005887 | MD | Primary |
Addresses
Primary practice location
14605 Potomac Branch Dr Ste 100
Woodbridge, VA 22191-3337
Mailing address
11350 McCormick Road
Executive Plaza 1, Suite 501
Hunt Valley, MD 21031
Phone (410) 329-1071
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0110005887 | MD | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513036800000",
"number": "1578078697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11350 MCCORMICK ROAD",
"address_2": "EXECUTIVE PLAZA 1, SUITE 501",
"city": "HUNT VALLEY",
"state": "MD",
"postal_code": "21031",
"telephone_number": "410-329-1071",
"fax_number": "410-329-1054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14605 POTOMAC BRANCH DR STE 100",
"city": "WOODBRIDGE",
"state": "VA",
"postal_code": "221913337",
"telephone_number": "703-738-4371",
"fax_number": "703-642-1876"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUNYANS",
"first_name": "ABIGAIL",
"middle_name": "YVONNE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-12",
"last_updated": "2017-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MD",
"license": "0110005887",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbridge, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.