is a Specialist in Hampton, Virginia. practices all healthcare services and medical treatments related to Specialist. The NPI Number for is 1073770905. The last update date is .
's current location address is 2207 Executive Dr Ste A, Hampton, Virginia. You can contact this provider via phone number 7578388525 and fax number 7578388527. The mailing address for is 2207 Executive Dr Ste A, Hampton, Virginia. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 2207 Executive Dr Ste A, Hampton, Virginia |
| Phone Number | 7578388525 |
| Fax Number | 7578388527 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1073770905 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 2207 Executive Dr Ste A |
|---|---|
| City | Hampton |
| State | Virginia (VA) |
| Post Code | 236662478 |
| Phone Number | 7578388525 |
| Fax Number | 7578388527 |
Provider's Primary Taxonomy Detail
| Speciality | Specialist |
|---|---|
| Taxonomy | 174400000X |
| Licence No | 101247612 |
|
Definition: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 438003934 | VA | -- |
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