MEDICARE: BARBARA K PAIGE

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	103TC0700X	Clinical Psychologist	0810000856	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	052857	OTHER	VA	ANTHEM BCBS

General Provider Information

NPI Number	:	1184654907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA K PAIGE

Provider Business Mailing Address
First Line	:	101 N LYNNHAVEN RD
Second Line	:	SUITE 103
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-7523
Country	:	US
Telephone Number	:	757-486-6955
Fax Number	:	757-486-3258

Provider Business Practice Location Address
First Line	:	101 N LYNNHAVEN RD
Second Line	:	SUITE 103
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-7523
Country	:	US
Telephone Number	:	757-486-6955
Fax Number	:	757-486-3258

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	09/05/2008

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Directions to “ BARBARA K PAIGE ” Practice Location

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