Healthcare Provider Details

I. General information

NPI: 1326402116
Provider Name (Legal Business Name): CHE MONTE TORRY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 THIMBLE SHOALS BLVD STE 1008
NEWPORT NEWS VA
23606-3585
US

IV. Provider business mailing address

739 THIMBLE SHOALS BLVD STE 1008
NEWPORT NEWS VA
23606-3585
US

V. Phone/Fax

Practice location:
  • Phone: 540-397-0094
  • Fax:
Mailing address:
  • Phone: 540-397-0094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number0102204998
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number0102204998
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: