MEDICARE: MR. CHRISTOPHER MICHAEL PROBST PA-C

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	363AM0700X	Medical Physician Assistant	0110840711	VA

General Provider Information

NPI Number	:	1578560215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER MICHAEL PROBST PA-C

Provider Business Mailing Address
First Line	:	5240 SUMMER CRES
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1950
Country	:	US
Telephone Number	:	757-473-1509
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 NIDER BLVD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23521-2701
Country	:	US
Telephone Number	:	757-314-6802
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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