Healthcare Provider Details

I. General information

NPI: 1932617974
Provider Name (Legal Business Name): MERGE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 TAYLOR RD STE G
CHESAPEAKE VA
23321-5525
US

IV. Provider business mailing address

4041 TAYLOR RD STE G
CHESAPEAKE VA
23321-5525
US

V. Phone/Fax

Practice location:
  • Phone: 757-487-2803
  • Fax: 757-487-2968
Mailing address:
  • Phone: 757-487-2803
  • Fax: 757-487-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. WHITTENEY L GUYTON
Title or Position: CEO
Credential:
Phone: 757-609-8614