Healthcare Provider Details

I. General information

NPI: 1932139326
Provider Name (Legal Business Name): VENKAT R IYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 KINGSBOROUGH SQ SUITE 100
CHESAPEAKE VA
23320-5041
US

IV. Provider business mailing address

PO BOX 7068
PORTSMOUTH VA
23707-0068
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-9294
  • Fax: 757-213-9374
Mailing address:
  • Phone: 757-686-3508
  • Fax: 757-686-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101249283
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number0101249283
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: