Healthcare Provider Details

I. General information

NPI: 1558654350
Provider Name (Legal Business Name): PELIN DUZENLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 OMNI BLVD STE 303
NEWPORT NEWS VA
23606-4434
US

IV. Provider business mailing address

12420 WARWICK BLVD BLDG 7 SUITE C
NEWPORT NEWS VA
23606-3001
US

V. Phone/Fax

Practice location:
  • Phone: 757-232-8769
  • Fax: 757-232-8875
Mailing address:
  • Phone: 757-594-3900
  • Fax: 757-595-0649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101258535
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: