Healthcare Provider Details

I. General information

NPI: 1578561841
Provider Name (Legal Business Name): WILLIAM KENAN RAND III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 GREENBRIER PKWY SUITE 100
CHESAPEAKE VA
23320-3697
US

IV. Provider business mailing address

1304 WINDSOR POINT RD
NORFOLK VA
23509-1312
US

V. Phone/Fax

Practice location:
  • Phone: 757-410-7390
  • Fax: 757-410-7395
Mailing address:
  • Phone: 757-857-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101034084
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: