Provider Demographics
NPI:1639196629
Name:WOMICK LEE, DEBRA A (DPM)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:A
Last Name:WOMICK LEE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 THIMBLE SHOALS BLVD
Mailing Address - Street 2:STE 300 B
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4544
Mailing Address - Country:US
Mailing Address - Phone:757-595-7634
Mailing Address - Fax:757-595-7635
Practice Address - Street 1:704 THIMBLE SHOALS BLVD
Practice Address - Street 2:STE 300 B
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4544
Practice Address - Country:US
Practice Address - Phone:757-595-7634
Practice Address - Fax:757-595-7635
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103001012213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU62898Medicare UPIN
VA1308720001Medicare NSC
VA480000644Medicare PIN