Provider Demographics
NPI:1336399195
Name:PASTORE, EMILY C (AUD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:C
Last Name:PASTORE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 OLD BRIDGE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LAKE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2495
Mailing Address - Country:US
Mailing Address - Phone:703-499-8787
Mailing Address - Fax:703-499-8222
Practice Address - Street 1:2070 OLD BRIDGE RD STE 103
Practice Address - Street 2:
Practice Address - City:LAKE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2495
Practice Address - Country:US
Practice Address - Phone:703-499-8787
Practice Address - Fax:703-499-8222
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP1909231H00000X
SC3971231H00000X
VA2201001383231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP00728623OtherMEDICARE RAILROAD PTAN GROUP CB0866
ME433863099Medicaid
SCQ40150A5449Medicare PIN
ME001071703Medicare PIN
ME001071702Medicare PIN
ME001071704Medicare PIN
ME001071701Medicare PIN