Basic Information
| Provider Information | |||||||||
| NPI: | 1164687190 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PASCUAL | ||||||||
| FirstName: | MARGIE | ||||||||
| MiddleName: | PANTANGCO | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7007 HARBOUR VIEW BLVD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234353657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572152784 | ||||||||
| FaxNumber: | 7572152728 | ||||||||
| Practice Location | |||||||||
| Address1: | 5818-D HARBOUR VIEW BLVD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576735890 | ||||||||
| FaxNumber: | 7576735946 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2008 | ||||||||
| LastUpdateDate: | 07/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101252144 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1164687190 | 05 | VA | MEDICAID |