Healthcare Provider Details

I. General information

NPI: 1366548042
Provider Name (Legal Business Name): MICHEL PAUL GINGRAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 HARTFORD RD
HAMPTON VA
23666-2409
US

IV. Provider business mailing address

2208 EXECUTIVE DR SUITE C
HAMPTON VA
23666-6603
US

V. Phone/Fax

Practice location:
  • Phone: 757-826-7516
  • Fax: 757-826-6232
Mailing address:
  • Phone: 757-826-7516
  • Fax: 757-826-6232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101044995
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: