MEDICARE: KAREN PATTERSON 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	011002431	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0110002431	OTHER	VA	VIRGINIA LICENSE

General Provider Information

NPI Number	:	1881738144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN PATTERSON PA-C

Provider Business Mailing Address
First Line	:	860 OMNI BLVD STE 101
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-4430
Country	:	US
Telephone Number	:	757-232-8769
Fax Number	:	757-232-8875

Provider Business Practice Location Address
First Line	:	351 EDWIN DR
Second Line	:	SUITE 102
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4559
Country	:	US
Telephone Number	:	757-499-5550
Fax Number	:	757-473-0919

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	02/07/2020

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