MEDICARE: MRS. KATHLEEN ANNE SCARBALIS 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	0110840338	VA

General Provider Information

NPI Number	:	1972553212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN ANNE SCARBALIS PA-C

Provider Business Mailing Address
First Line	:	111 CLUB HIGHLAND STE 200
Second Line	:
City	:	NELLYSFORD
State	:	VA
Zip	:	22958-2349
Country	:	US
Telephone Number	:	719-201-1480
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 CLUB HIGHLAND STE 200
Second Line	:
City	:	NELLYSFORD
State	:	VA
Zip	:	22958-2349
Country	:	US
Telephone Number	:	719-201-1480
Fax Number	:

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	04/26/2021

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