1184220287 NPI number — MR. VICTOR ANTHONY KUCHMANER HAS

Table of content: MR. VICTOR ANTHONY KUCHMANER HAS (NPI 1184220287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184220287 NPI number — MR. VICTOR ANTHONY KUCHMANER HAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUCHMANER
Provider First Name:
VICTOR
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
HAS
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:
1184220287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 N WITCHDUCK RD STE 103
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:
23462-1947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-222-5991
Provider Business Mailing Address Fax Number:
833-687-8324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
490 CARATOKE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOYOCK
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27958-8672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-435-6001
Provider Business Practice Location Address Fax Number:
833-687-8324
Provider Enumeration Date:
12/05/2020

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: 237700000X , with the licence number:  1566 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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