Healthcare Provider Details

I. General information

NPI: 1790810455
Provider Name (Legal Business Name): VIRGINIA NEUROLOGY AND SLEEP CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 KINGSBOROUGH SQ STE E
CHESAPEAKE VA
23320-4944
US

IV. Provider business mailing address

637 KINGSBOROUGH SQ SUITE E
CHESAPEAKE VA
23320-4944
US

V. Phone/Fax

Practice location:
  • Phone: 757-778-2247
  • Fax: 833-471-4175
Mailing address:
  • Phone: 757-410-2804
  • Fax: 757-410-2813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KATHY GLENN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 757-266-5917