Provider Demographics
NPI:1871656819
Name:PARKS, BARBARA L (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:PARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 COLONIAL MEDICAL CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3035
Mailing Address - Country:US
Mailing Address - Phone:757-416-6750
Mailing Address - Fax:757-416-6830
Practice Address - Street 1:1060 FIRST COLONIAL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3002
Practice Address - Country:US
Practice Address - Phone:757-491-9065
Practice Address - Fax:757-395-6321
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101046453207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA318808OtherANTHEM BC BS
VA541636896OtherTAX ID
VA006084311Medicaid
VAC12157Medicare UPIN
VA110007694Medicare ID - Type Unspecified