Healthcare Provider Details

I. General information

NPI: 1720047558
Provider Name (Legal Business Name): VIRGINIA L HERBERT M.D, F.A.C.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7554 HOSPITAL DR STE D-303
GLOUCESTER VA
23061-4178
US

IV. Provider business mailing address

13 GUYER ST
LEBANON NH
03766-1210
US

V. Phone/Fax

Practice location:
  • Phone: 804-693-3400
  • Fax:
Mailing address:
  • Phone: 603-727-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14767
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number14767
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM3015
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101256109
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: