Individual provider Active NPI

Matthew Joseph Dulan, PA-C

  • Physician Assistant
  • Fairfax, VA
National Provider Identifier
1861172819
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
6120 Green Cap PL
Fairfax, VA 22030-5915
Phone
(571) 271-9850
NPI assigned
Jul 24, 2023
Last updated
Sep 23, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0110009606 VA
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

6120 Green Cap PL
Fairfax, VA 22030-5915

Mailing address

6120 Green Cap PL
Fairfax, VA 22030-5915
Phone (571) 271-9850

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, DC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240329002009 VA Practitioner - Physician Assistant 8022456888 Reassigns benefits to 1 organization
I20260527004178 DC Practitioner - Physician Assistant 8022456888 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
May accept Medicare assignment
Group practices
MWHC Urgent Care LLCGroup PAC ID 8921338427, 20 clinicians
Centers for Advanced Orthopaedics LLCGroup PAC ID 8123260981, shared by 42 NPIs, 599 clinicians

Practice addresses (Care Compare)

11131 Journal Pkwy
Suite a
King George, VA 22485-3468
Phone (540) 709-5173

14348 Gideon Dr
Woodbridge, VA 22192-4640
Phone (703) 490-1112

4900 Plank Rd
Suite 101
Fredericksburg, VA 22407-6626
Phone (540) 741-0679

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
MWHC Urgent Care LLC CurrentSince Nov 18, 2024 Accepting new patients
Orthopaedic Associates of Central Maryland, PA Past Accepting new patients

Locations

1340 Central Park Blvd
Ste 100
Fredericksburg, VA 22401

11131 Journal Pkwy
Ste A
King George, VA 22485
Phone (540) 709-5173

Interoperability endpoints

  • Direct secure messaging: mdulan126703@marywashingtonhealthcare.direct-ci.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727049600000",
    "number": "1861172819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6120 GREEN CAP PL",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305915",
            "telephone_number": "571-271-9850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6120 GREEN CAP PL",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305915",
            "telephone_number": "571-271-9850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DULAN",
        "first_name": "MATTHEW",
        "middle_name": "JOSEPH",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-24",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110009606",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.