Provider Demographics
NPI:1558114470
Name:PAYNE, VICTORIA MARY
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARY
Last Name:PAYNE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:PAYNE
Other - Last Name:ARRIAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10510 JEFFERSON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-3102
Mailing Address - Country:US
Mailing Address - Phone:757-594-3800
Mailing Address - Fax:757-591-9021
Practice Address - Street 1:10510 JEFFERSON AVE STE A
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-3102
Practice Address - Country:US
Practice Address - Phone:757-594-3800
Practice Address - Fax:757-591-9021
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
568946544OtherBCBS
5874OtherHEALTH PARTNERS
DC236Medicaid