Healthcare Provider Details

I. General information

NPI: 1417955204
Provider Name (Legal Business Name): RUTH HELEN INNES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUTH HELEN INNES MD

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BERNARDINE DR
NEWPORT NEWS VA
23602-4404
US

IV. Provider business mailing address

860 OMNI BLVD SUITE 303
NEWPORT NEWS VA
23606-4430
US

V. Phone/Fax

Practice location:
  • Phone: 757-886-6877
  • Fax: 757-947-3232
Mailing address:
  • Phone: 757-232-8777
  • Fax: 757-232-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101235103
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101235103
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: