Individual
DR. BEDE A.R. PANTAZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
9702 GAYTON RD, #181, RICHMOND, VA 23238-4907
(804) 741-7500
(804) 741-7900
Mailing address
P.O. BOX 586, GLASGOW, VA 24555
(540) 461-5555
(804) 741-7900
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810002816
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007712537
—
VA
01
—
245585
BLUE CROSS PIN
VA
Enumeration date
04/26/2006
Last updated
10/23/2019
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