Doctor Name: | REBECCA BACZUK |
NPI Number: | 1023093812 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 0101236813 |
Business Practice Address: | 2388 Bays Edge Ave Virginia Beach, VA - 234511056 |
Business Phone Number: | 7574965621 |
Business Fax Number: | |
Mailing Address: | 2388 Bays Edge Ave, VIRGINIA BEACH |
State: | VA |
Postal Code: | 234511056 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 12/14/2005 |
NPI Last Update Date: | 10/10/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171000000X |
License Number: | 0101236813 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Military Health Care Provider |
Taxonomy Specialization: | |
Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |