Provider Demographics
NPI:1639281728
Name:BECKER, PAMELA STONE (CNM)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:STONE
Last Name:BECKER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2296 OPITZ BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3346
Mailing Address - Country:US
Mailing Address - Phone:703-680-5327
Mailing Address - Fax:703-680-3650
Practice Address - Street 1:2296 OPITZ BLVD STE 350
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3346
Practice Address - Country:US
Practice Address - Phone:703-680-5327
Practice Address - Fax:703-680-3650
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
VA24165339176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7793308Medicaid
VA7793308Medicaid