Provider Demographics
NPI:1003419128
Name:PANDAJIS, MARTHA BRICKEY (PA-C)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:BRICKEY
Last Name:PANDAJIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2859 VIRGINIA BEACH BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7622
Mailing Address - Country:US
Mailing Address - Phone:757-644-4615
Mailing Address - Fax:276-209-1307
Practice Address - Street 1:2859 VIRGINIA BEACH BLVD STE 108
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7622
Practice Address - Country:US
Practice Address - Phone:757-644-4615
Practice Address - Fax:276-209-1307
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXPA14907363AM0700X
VA0110009682363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty