Healthcare Provider Details
I. General information
NPI: 1225172810
Provider Name (Legal Business Name): SOUTHEASTERN VIRGINIA TRAINING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2100 STEPPINGSTONE SQ
CHESAPEAKE VA
23320-2517
US
IV. Provider business mailing address
2100 STEPPINGSTONE SQUARE
CHESAPEAKE VA
23320
US
V. Phone/Fax
- Phone: 757-424-8201
- Fax: 757-424-8348
- Phone: 757-424-8201
- Fax: 757-424-8348
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208M00000X |
| Taxonomy | Hospitalist Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
ROBERT
D
SHREWSBERRY
Title or Position: DIRECTOR
Credential: PHD
Phone: 757-424-8201