MEDICARE: EMILY SARAH DUDLEY PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0110002824	VA

General Provider Information

NPI Number	:	1154583441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY SARAH DUDLEY PA

Provider Business Mailing Address
First Line	:	856 J CLYDE MORRIS BLVD
Second Line	:	STE A
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-1318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2855 DENBIGH BLVD
Second Line	:	SUITE A
City	:	GRAFTON
State	:	VA
Zip	:	23692-6501
Country	:	US
Telephone Number	:	757-968-5700
Fax Number	:	757-968-5717

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	10/22/2013

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