Provider Demographics
NPI:1407161029
Name:WALIA, MEENAL KAUR (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:MEENAL
Middle Name:KAUR
Last Name:WALIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:5231 JOHN TYLER HWY
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185
Practice Address - Country:US
Practice Address - Phone:757-220-8300
Practice Address - Fax:757-565-5338
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10064696POtherOPTIMA HEALTH
VA1407161029Medicaid
NC8101078Medicaid
VAPAROtherCORVEL/CORCARE
VAPAROtherMULTIPLAN
VA-020OtherTRICARE/CHAMPUS
VA416430OtherANTHEM
VAPAROtherUSA MANAGED CARE
VAPAROtherUSA MANAGED CARE
NC8101078Medicaid