1174615447 NPI number — NORFOLK PLASTIC SURGERY, PC

Table of content: (NPI 1174615447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174615447 NPI number — NORFOLK PLASTIC SURGERY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORFOLK PLASTIC SURGERY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAWRENCE B. COLEN PLASTIC SURGERY
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174615447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6161 KEMPSVILLE CIR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23502-3932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-466-1000
Provider Business Mailing Address Fax Number:
757-466-7788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6161 KEMPSVILLE CIR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23502-3932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-466-1000
Provider Business Practice Location Address Fax Number:
757-466-7788
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CREECH
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BILLING COORDINATOR
Authorized Official Telephone Number:
919-763-0123

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X , with the licence number:  0101044977 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086S0122X , with the licence number: 0101056114 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0101056114 . This is a "LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 24004907 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 278499 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 295242 . This is a "BCBS GROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 006900151 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: E71399 . This is a "UPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 006902090 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65573 . This is a "OPTIMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: H36682 . This is a "UPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 024565 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15781 . This is a "OPTIMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3755 . This is a "ASPRS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 890686C , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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