Pavilack, Mark A

Pavilack, Mark A is an individual health care provider with primary practice located at 3235 Academy Ave Suite 200, Portsmouth VA 23703-3200. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Pavilack, Mark A can be contacted via phone (757) 483-0400.

Contact Information

Primary practice address
3235 Academy Ave Suite 200 Portsmouth VA 23703-3200
Phone: (757) 483-0400
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 0101232985 Virginia

Profile Details

NPI number 1245238096
LBN Legal business name Pavilack, Mark A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 13th, 2005
Last updated Apr 30th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245238096 NPPES
Virginia MEDICAID 6309909
Virginia MEDICAID 1245238096
Virginia Other 247538

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