Provider Demographics
NPI:1275603763
Name:BARBABELLA, STACEY ANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ANNE
Last Name:BARBABELLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:ANNE
Other - Last Name:RABISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2000 MEADE PKWY
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4259
Mailing Address - Country:US
Mailing Address - Phone:757-539-0251
Mailing Address - Fax:757-934-9497
Practice Address - Street 1:2000 MEADE PKWY
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4259
Practice Address - Country:US
Practice Address - Phone:757-539-0251
Practice Address - Fax:757-934-9497
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840772363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00372759OtherRAILROAD MEDICARE
VAP00372759OtherRAILROAD MEDICARE
VAQ76396Medicare UPIN