Healthcare Provider Details

I. General information

NPI: 1700939980
Provider Name (Legal Business Name): HAMPTON ROADS OTOLARYNGOLOGY ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ENTERPRISE PKWY SUITE 300
HAMPTON VA
23666-6249
US

IV. Provider business mailing address

901 ENTERPRISE PKWY SUITE 300
HAMPTON VA
23666-6249
US

V. Phone/Fax

Practice location:
  • Phone: 757-825-2500
  • Fax: 757-825-2521
Mailing address:
  • Phone: 757-825-2500
  • Fax: 757-825-2521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARON A MARCUM
Title or Position: OFFICE MANAGER
Credential:
Phone: 757-825-2500