Healthcare Provider Details

I. General information

NPI: 1225004864
Provider Name (Legal Business Name): JASON TODD COMBS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 COLISEUM DR STE 350
HAMPTON VA
23666
US

IV. Provider business mailing address

4000 COLISEUM DR STE 350
HAMPTON VA
23666
US

V. Phone/Fax

Practice location:
  • Phone: 757-827-2127
  • Fax: 757-827-2255
Mailing address:
  • Phone: 757-827-2127
  • Fax: 757-827-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2007-01470
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101235348
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: