Healthcare Provider Details

I. General information

NPI: 1821154816
Provider Name (Legal Business Name): KEVIN MICHAEL ORSTEAD PH.D., C.S.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 HARWICH DR
CHESAPEAKE VA
23322-9535
US

IV. Provider business mailing address

1032 HARWICH DR
CHESAPEAKE VA
23322-9535
US

V. Phone/Fax

Practice location:
  • Phone: 757-482-4701
  • Fax: 757-482-4701
Mailing address:
  • Phone: 757-482-4701
  • Fax: 757-482-4701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: