Provider Demographics
NPI:1548919327
Name:BATTLE, PAUL JEROME
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:JEROME
Last Name:BATTLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 PORTSMOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2530
Mailing Address - Country:US
Mailing Address - Phone:757-773-4677
Mailing Address - Fax:757-405-1520
Practice Address - Street 1:4201 PORTSMOUTH BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-2530
Practice Address - Country:US
Practice Address - Phone:757-773-4677
Practice Address - Fax:757-405-1520
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle