1932122025 NPI number — MRS. CHRISTINE CATHERINE STABLEY PA-C

Table of content: MRS. CHRISTINE CATHERINE STABLEY PA-C (NPI 1932122025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932122025 NPI number — MRS. CHRISTINE CATHERINE STABLEY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STABLEY
Provider First Name:
CHRISTINE
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLMAN
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
CATHERINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932122025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40698 THISTLE GATE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALDIE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20105-2885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19441 GOLF VISTA PLAZA SUITE 230 & 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176-8272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-729-3420
Provider Business Practice Location Address Fax Number:
703-729-3422
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA9100640 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 0110006006 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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