Provider Demographics
NPI:1538268669
Name:MAGNUSSEN, DAVID T (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:T
Last Name:MAGNUSSEN
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:230 CLEARFIELD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1832
Mailing Address - Country:US
Mailing Address - Phone:757-321-3383
Mailing Address - Fax:757-321-3332
Practice Address - Street 1:1800 CAMELOT DR
Practice Address - Street 2:SUITE 300
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2440
Practice Address - Country:US
Practice Address - Phone:757-321-3383
Practice Address - Fax:757-321-3332
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT002748363A00000X
VA0110001697363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA022077G72Medicare PIN