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NPI Code Detail

MEDICARE: MR. GEORGE L MARKHAM III PAC

MEDICARE: MR. GEORGE L MARKHAM III PAC
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
1363A00000XPhysician Assistant0110001349VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770550337
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GEORGE L MARKHAM III PAC
Provider Business Mailing Address
First Line : 6632 INDIAN RIVER RD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23464-3442
Country : US
Telephone Number : 757-424-4300
Fax Number : 757-523-0632
Provider Business Practice Location Address
First Line : 3241 WESTERN BRANCH BLVD
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23321-5260
Country : US
Telephone Number : 757-686-3508
Fax Number : 757-686-0541
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2006
Last Update Date : 08/19/2010

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