Healthcare Provider Details

I. General information

NPI: 1215030549
Provider Name (Legal Business Name): KRISTA PINE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5477 MOORETOWN RD
WILLIAMSBURG VA
23188-2108
US

IV. Provider business mailing address

139 W LAYDON WAY
POQUOSON VA
23662-2160
US

V. Phone/Fax

Practice location:
  • Phone: 757-565-0106
  • Fax: 757-565-0620
Mailing address:
  • Phone: 757-585-5417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101244458
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: