Provider Demographics
NPI:1699864058
Name:WERBIN, PAUL (CRNA)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:WERBIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3884 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-1606
Mailing Address - Country:US
Mailing Address - Phone:757-460-0249
Mailing Address - Fax:
Practice Address - Street 1:465 N GREAT NECK RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4064
Practice Address - Country:US
Practice Address - Phone:757-481-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024090514367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADF0637OtherRAILROAD MEDICARE GROUP
VAC09740OtherMEDICARE GROUP
VA541923175OtherTAX ID
VAP00335734OtherRAILROAD MEDICARE
VA00W921C01Medicare PIN