1922143270 NPI number — DR. CARRIE FANCETT PAGELS PH.D.

Table of content: DR. CARRIE FANCETT PAGELS PH.D. (NPI 1922143270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922143270 NPI number — DR. CARRIE FANCETT PAGELS PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAGELS
Provider First Name:
CARRIE
Provider Middle Name:
FANCETT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FANCETT
Provider Other First Name:
CARRIE
Provider Other Middle Name:
SUSAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922143270
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:
372 MCLAWS CIR.
Provider Second Line Business Mailing Address:
STE. 2
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23185-5648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-564-3100
Provider Business Mailing Address Fax Number:
757-564-3500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
372 MCLAWS CIR.
Provider Second Line Business Practice Location Address:
STE. 2
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23185-5648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-564-3100
Provider Business Practice Location Address Fax Number:
757-564-3500
Provider Enumeration Date:
02/21/2007

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: 103TC0700X , with the licence number:  0810002664 , 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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