1831101724 NPI number — KENNETH FRUMKIN M.D.

Table of content: DR. SAMANTHA ANN MCBRYDE PHARMD (NPI 1821552985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831101724 NPI number — KENNETH FRUMKIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRUMKIN
Provider First Name:
KENNETH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1831101724
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4536 BONNEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23462-3869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-490-9388
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
736 BATTLEFIELD BLVD N
Provider Second Line Business Practice Location Address:
CHESAPEAKE GENERAL HOSPITAL
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320-4941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-312-6200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X , with the licence number:  0101046773 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 890518Y , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0518Y . This is a "BLUE CROSS BLUE SHIELD NC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 082480 . This is a "BLUE CROSS BLUE SHIELD VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 15853 . This is a "OPTIMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3900570 . This is a "OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 251490 . This is a "MAMSI/MDIPA" identifier . This identifiers is of the category "OTHER".




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