Provider Demographics
NPI:1679619613
Name:DEWITZ, LAURA REMAKLUS (PAC, MHS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:REMAKLUS
Last Name:DEWITZ
Suffix:
Gender:F
Credentials:PAC, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 INDEPENDENCE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5205
Mailing Address - Country:US
Mailing Address - Phone:757-420-0530
Mailing Address - Fax:757-420-0488
Practice Address - Street 1:640 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5205
Practice Address - Country:US
Practice Address - Phone:757-420-0530
Practice Address - Fax:757-420-0488
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001403363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP51218Medicare UPIN
VA00X6025C02Medicare PIN