Healthcare Provider Details

I. General information

NPI: 1912089517
Provider Name (Legal Business Name): BARBARA A ALBERT PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2238 TODDS LN
HAMPTON VA
23666-3159
US

IV. Provider business mailing address

2238 TODDS LN
HAMPTON VA
23666-3159
US

V. Phone/Fax

Practice location:
  • Phone: 757-315-8100
  • Fax: 414-622-3886
Mailing address:
  • Phone: 757-315-8100
  • Fax: 414-622-3886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number110840788
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: