Provider Demographics
NPI:1831423839
Name:PASTOR, GALADRIEL LEA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:GALADRIEL
Middle Name:LEA
Last Name:PASTOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:GALADRIEL
Other - Middle Name:LEA
Other - Last Name:SPAULDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:450 GARRISONVILLE RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554
Mailing Address - Country:US
Mailing Address - Phone:703-522-2727
Mailing Address - Fax:540-288-3327
Practice Address - Street 1:450 GARRISONVILLE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554
Practice Address - Country:US
Practice Address - Phone:703-522-2727
Practice Address - Fax:540-288-3327
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003092363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant