MEDICARE: CHANDLER PAIGE WINNIE PA

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	363A00000X	Physician Assistant	0110010297	VA

General Provider Information

NPI Number	:	1710755335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDLER PAIGE WINNIE PA

Provider Business Mailing Address
First Line	:	3241 WESTERN BRANCH BLVD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5260
Country	:	US
Telephone Number	:	757-967-8622
Fax Number	:	757-686-0541

Provider Business Practice Location Address
First Line	:	1060 FIRST COLONIAL RD
Second Line	:
City	:	VIRGINIA BCH
State	:	VA
Zip	:	23454
Country	:	US
Telephone Number	:	757-967-8622
Fax Number	:	757-686-0541

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

Provider Enumeration Date	:	12/13/2023
Last Update Date	:	09/06/2024

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Directions to “ CHANDLER PAIGE WINNIE PA” Practice Location

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