MEDICARE: DR. KRISTA PINE M.D.

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	2084P0800X	Psychiatry Physician	0101244458	VA

General Provider Information

NPI Number	:	1215030549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTA PINE M.D.

Provider Business Mailing Address
First Line	:	139 W LAYDON WAY
Second Line	:
City	:	POQUOSON
State	:	VA
Zip	:	23662-2160
Country	:	US
Telephone Number	:	757-585-5417
Fax Number	:

Provider Business Practice Location Address
First Line	:	5477 MOORETOWN RD
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-2108
Country	:	US
Telephone Number	:	757-565-0106
Fax Number	:	757-565-0620

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

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	02/03/2012

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