Provider Demographics
NPI:1114956638
Name:KING, PATRICIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 GREENBRIER CIR STE 209
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2642
Mailing Address - Country:US
Mailing Address - Phone:757-436-2444
Mailing Address - Fax:757-547-4584
Practice Address - Street 1:816 GREENBRIER CIR STE 209
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2642
Practice Address - Country:US
Practice Address - Phone:757-436-2444
Practice Address - Fax:757-547-4584
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA48-1265866174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010191556Medicaid
VA010191556Medicaid