Luis E Vidal, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110008968 Issued in VA

Practice address

9300 Dewitt Loop
Fort Belvoir, VA 22060-5285

Phone

(571) 231-0374

NPI assigned

Sep 12, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1189555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1902091986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9300 DEWITT LOOP",
            "city": "FORT BELVOIR",
            "state": "VA",
            "postal_code": "220605285",
            "telephone_number": "571-231-0374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9300 DEWITT LOOP",
            "city": "FORT BELVOIR",
            "state": "VA",
            "postal_code": "220605285",
            "telephone_number": "571-231-0374"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "650 Joel Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Campbell",
            "state": "KY",
            "postal_code": "422235318",
            "country_code": "US",
            "telephone_number": "270-798-8372",
            "fax_number": "270-956-0180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VIDAL",
        "first_name": "LUIS",
        "middle_name": "E",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-12",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110008968",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA STATE BOARD OF MEDICINE PHYSICIAN ASSISTANT LICENSE",
            "identifier": "0110008968",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janice C Vaz, FNP-BC
• Elizabeth Annabel Velazquez, LCSW-C
• Saro Verghese, M.D
• Pramvir Singh Verma, M.D.
• Brittany Vernon
• Jennifer L Viera, M.D.
• Charisse Villareal, MD
• Elaina Suzanne Virostko, RDN
• Thuthu Lieu Vo, R.PH
• Leslie Rachel Vojta, M.D.

• Physician Assistant in Fort Belvoir, VA
• Providers in Fort Belvoir, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.