Provider Demographics
NPI:1265420756
Name:AGNEW, PATRICK S (DPM)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:S
Last Name:AGNEW
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6477 COLLEGE PARK SQ
Mailing Address - Street 2:SUITE 106
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-3611
Mailing Address - Country:US
Mailing Address - Phone:757-523-0414
Mailing Address - Fax:757-523-2047
Practice Address - Street 1:6477 COLLEGE PARK SQ
Practice Address - Street 2:SUITE 106
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3611
Practice Address - Country:US
Practice Address - Phone:757-523-0414
Practice Address - Fax:757-523-2047
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000759213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009303278Medicaid
VAT21623Medicare UPIN
VA009303278Medicaid
VA480000589Medicare PIN