Healthcare Provider Details

I. General information

NPI: 1871501171
Provider Name (Legal Business Name): DEENA S OBROKTA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 DENBIGH BLVD SUITE 400
NEWPORT NEWS VA
23608-4413
US

IV. Provider business mailing address

606 DENBIGH BLVD SUITE 400
NEWPORT NEWS VA
23608-4413
US

V. Phone/Fax

Practice location:
  • Phone: 757-883-0780
  • Fax: 757-883-0783
Mailing address:
  • Phone: 757-883-0780
  • Fax: 757-883-0783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102050070
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: