Healthcare Provider Details

I. General information

NPI: 1295799583
Provider Name (Legal Business Name): SHERWIN MARK ANGUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 SIGNATURE WAY
HAMPTON VA
23666-5966
US

IV. Provider business mailing address

4 CASCADE VIEW CT
HAMPTON VA
23666-6017
US

V. Phone/Fax

Practice location:
  • Phone: 757-723-3549
  • Fax: 757-723-2229
Mailing address:
  • Phone: 757-838-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101234719
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: