Healthcare Provider Details

I. General information

NPI: 1003890005
Provider Name (Legal Business Name): CONNIE SWARTZ KETTEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 OYSTER POINT RD
NEWPORT NEWS VA
23606-4570
US

IV. Provider business mailing address

811 REDGATE AVE
NORFOLK VA
23507-1515
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-4851
  • Fax:
Mailing address:
  • Phone: 757-668-7007
  • Fax: 757-668-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101237424
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: