Healthcare Provider Details

I. General information

NPI: 1982244083
Provider Name (Legal Business Name): CORNERSTONE PROFESSIONAL ORTHOPAEDICS SPORTS 4 CHRIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 KINGSBOROUGH SQ STE D
CHESAPEAKE VA
23320-4944
US

IV. Provider business mailing address

PO BOX 4222
VIRGINIA BEACH VA
23454-0222
US

V. Phone/Fax

Practice location:
  • Phone: 757-746-5342
  • Fax: 833-954-0875
Mailing address:
  • Phone: 757-746-5342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS DAVID DUNCAN
Title or Position: PRESIDENT CORNERSTONE PROFESSIONAL
Credential: MD
Phone: 757-746-5342