Provider Demographics
NPI:1417361031
Name:BEHM, MARY ASHLEY
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ASHLEY
Last Name:BEHM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:A
Other - Last Name:BEASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:397 LITTLE NECK RD STE 120
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-5774
Mailing Address - Country:US
Mailing Address - Phone:757-395-1600
Mailing Address - Fax:757-961-9359
Practice Address - Street 1:397 LITTLE NECK RD STE 120
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5774
Practice Address - Country:US
Practice Address - Phone:757-395-1600
Practice Address - Fax:757-961-9359
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA363AS0400X
VA0110004615363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical