Healthcare Provider Details

I. General information

NPI: 1538318175
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA/STATE DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 J CLYDE MORRIS BLVD
NEWPORT NEWS VA
23601-1927
US

IV. Provider business mailing address

416 J CLYDE MORRIS BLVD
NEWPORT NEWS VA
23601-1927
US

V. Phone/Fax

Practice location:
  • Phone: 757-594-7096
  • Fax: 757-594-7449
Mailing address:
  • Phone: 757-594-7096
  • Fax: 757-594-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number1223D0001X
License Number StateVA

VIII. Authorized Official

Name: DR. DAVID H TRUMP
Title or Position: HEALTH DIRECTOR
Credential: M.D.
Phone: 757-594-7305