Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Theodora Anna Squire

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1417591660

Theodora Anna Squire is a Physician Assistant in Glen Allen, Virginia. Qualified in 2021, 5 years ago. Practices with Gastroenterology Associates of Northern Virginia, LLC, a 97-clinician group, accepts Medicare assignment and offers telehealth.

Years since qualifying
5
In the registry since
2019
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Practice location Address checks out

2151 Old Brick Rd
Glen Allen, VA 23060-5837
Phone: (703) 850-8981
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1417591660
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedOctober 31, 2019
Last updated in NPPESOctober 31, 2019

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Gastroenterology Associates Of Northern Virginia, Llc — 97 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

Other providers in Glen Allen