Provider Demographics
NPI:1316917644
Name:PACE, MARIA E (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:PACE
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14540 JOHN MARSHALL HWY STE 102
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-1693
Practice Address - Country:US
Practice Address - Phone:703-712-6062
Practice Address - Fax:571-445-3075
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012322112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6688-0023OtherCAREFIRST
VA7242085Medicaid
VA7242115Medicaid
VA7242093Medicaid
VA7242123Medicaid
VA7247419Medicaid
VAG82220Medicare UPIN
VA7242115Medicaid