Healthcare Provider Details

I. General information

NPI: 1982836946
Provider Name (Legal Business Name): CAMILLE HABIB MPA,PA-C,ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 NEWTOWN RD
VIRGINIA BEACH VA
23462-1793
US

IV. Provider business mailing address

5000 COX RD
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 757-473-8400
  • Fax:
Mailing address:
  • Phone: 804-968-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110003071
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: