Healthcare Provider Details

I. General information

NPI: 1770722175
Provider Name (Legal Business Name): HAMPTON ROADS PROTON BEAM THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 ENTERPRISE PARKWAY
HAMPTON VA
23666-5800
US

IV. Provider business mailing address

40 ENTERPRISE PARKWAY
HAMPTON VA
23666-5800
US

V. Phone/Fax

Practice location:
  • Phone: 757-251-6800
  • Fax: 757-251-6920
Mailing address:
  • Phone: 757-251-6800
  • Fax: 757-251-6920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DORETHA J. SPELLS
Title or Position: VICE PRESIDENT OF BUSINESS AFFAIRS
Credential:
Phone: 757-727-5213