Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Larry C Mack-Wilson, PA

Individual provider Medical Physician Assistant · NPI 1235413667

Larry C Mack-Wilson, PA is a Physician Assistant in Reston, Virginia. Qualified in 2011, 15 years ago. Practices with Privia Medical Group, LLC, a 1,518-clinician group and accepts Medicare assignment. Licensed in Virginia.

Years since qualifying
15
Licensed in
VA
In the registry since
2011
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1850 Town Center Pkwy
Reston, VA 20190-3219
Phone: (703) 689-9039
Fax: (703) 689-9109
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 0110003693 (VA)

Record details

NPI number1235413667
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedOctober 4, 2011
Last updated in NPPESOctober 4, 2011

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Privia Medical Group, Llc — 1518 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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