1700858685 NPI number — DR. DEBORAH MICHELLE EDWARDS PSY D

Table of content: DR. DEBORAH MICHELLE EDWARDS PSY D (NPI 1700858685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700858685 NPI number — DR. DEBORAH MICHELLE EDWARDS PSY D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS
Provider First Name:
DEBORAH
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700858685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
780 LYNNHAVEN PKWY
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23452-7332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-468-0550
Provider Business Mailing Address Fax Number:
757-468-9992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
780 LYNNHAVEN PKWY
Provider Second Line Business Practice Location Address:
SUITE 400 ATLANTIC PSYCHIATRIC SERVICES
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23452-7332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-468-0550
Provider Business Practice Location Address Fax Number:
757-468-9992
Provider Enumeration Date:
02/03/2006

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: 103T00000X , with the licence number:  0810003000 , 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)

  • Identifier: 2108610 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 327267 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223200 . This is a "COM PSYCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 588516 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: C01884 . This is a "MCARE GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 081724M . This is a "SENTARA OPTIMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 246378 . This is a "ANTHEM PPO BCBS" identifier . This identifiers is of the category "OTHER".




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