Healthcare Provider Details

I. General information

NPI: 1609455450
Provider Name (Legal Business Name): AFFINITY PALLIATIVE OF VIRGINIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 THIMBLE SHOALS BLVD STE C
NEWPORT NEWS VA
23606-2574
US

IV. Provider business mailing address

714 THIMBLE SHOALS BLVD STE C
NEWPORT NEWS VA
23606-2574
US

V. Phone/Fax

Practice location:
  • Phone: 757-330-8050
  • Fax: 757-952-2656
Mailing address:
  • Phone: 757-330-8050
  • Fax: 757-952-2656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMUEL STERN
Title or Position: CEO
Credential:
Phone: 510-499-9977