Healthcare Provider Details

I. General information

NPI: 1861699100
Provider Name (Legal Business Name): RUSSELL P BALMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 GREENBRIER CIR STE 100
CHESAPEAKE VA
23320-2645
US

IV. Provider business mailing address

816 GREENBRIER CIR STE 100
CHESAPEAKE VA
23320-2645
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax: 757-301-8803
Mailing address:
  • Phone: 804-207-6737
  • Fax: 757-301-8803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101250109
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: