Provider Demographics
NPI:1124038591
Name:HEALEY, DEBORAH ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ELIZABETH
Last Name:HEALEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:ELIZABETH
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 EAST SOUTH STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5215
Mailing Address - Country:US
Mailing Address - Phone:434-296-0456
Mailing Address - Fax:434-296-0456
Practice Address - Street 1:100 EAST SOUTH STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5215
Practice Address - Country:US
Practice Address - Phone:434-296-0456
Practice Address - Fax:434-296-0456
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010386812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10007186Medicaid
C47470Medicare UPIN