Healthcare Provider Details

I. General information

NPI: 1598715211
Provider Name (Legal Business Name): CAROL ANNE PURDY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL PURDY WORRILL D.O.

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12997 WARWICK BLVD
NEWPORT NEWS VA
23602-8352
US

IV. Provider business mailing address

12997 WARWICK BLVD
NEWPORT NEWS VA
23602-8352
US

V. Phone/Fax

Practice location:
  • Phone: 757-369-3357
  • Fax:
Mailing address:
  • Phone: 757-369-3357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102049937
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number0102049937
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: