Healthcare Provider Details

I. General information

NPI: 1467401869
Provider Name (Legal Business Name): DAVID G DORBAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 RAINTREE RD SUITE 200A
CHESAPEAKE VA
23321-3741
US

IV. Provider business mailing address

4012 RAINTREE RD SUITE 200A
CHESAPEAKE VA
23321-3741
US

V. Phone/Fax

Practice location:
  • Phone: 757-488-2223
  • Fax: 757-488-8398
Mailing address:
  • Phone: 757-488-2223
  • Fax: 757-488-8398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101237635
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: