Healthcare Provider Details

I. General information

NPI: 1477204980
Provider Name (Legal Business Name): LOTUS LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 CALHOUN ST
HAMPTON VA
23669-2434
US

IV. Provider business mailing address

11747 JEFFERSON AVE STE 6C
NEWPORT NEWS VA
23606-1998
US

V. Phone/Fax

Practice location:
  • Phone: 757-438-7004
  • Fax:
Mailing address:
  • Phone: 757-438-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: VERONICA CHARITY BARNES
Title or Position: CEO
Credential: NP
Phone: 757-438-7004