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NPI Code Detail

MEDICARE: DR. DEBORAH MICHELLE EDWARDS PSY D

MEDICARE: DR. DEBORAH MICHELLE EDWARDS PSY 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
1103T00000XPsychologist0810003000VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12108610OTHERMAMSI
2327267OTHERMANAGED HEALTH NETWORK
3223200OTHERCOM PSYCH
4588516OTHERMAGELLAN
5C01884OTHERMCARE GROUP
6081724MOTHERSENTARA OPTIMA
7246378OTHERANTHEM PPO BCBS

General Provider Information

NPI Number : 1700858685
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEBORAH MICHELLE EDWARDS PSY D
Provider Business Mailing Address
First Line : 780 LYNNHAVEN PKWY
Second Line : SUITE 400
City : VIRGINIA BEACH
State : VA
Zip : 23452-7332
Country : US
Telephone Number : 757-468-0550
Fax Number : 757-468-9992
Provider Business Practice Location Address
First Line : 780 LYNNHAVEN PKWY
Second Line : SUITE 400 ATLANTIC PSYCHIATRIC SERVICES
City : VIRGINIA BEACH
State : VA
Zip : 23452-7332
Country : US
Telephone Number : 757-468-0550
Fax Number : 757-468-9992
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2006
Last Update Date : 07/08/2007

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