Healthcare Provider Details

I. General information

NPI: 1396725842
Provider Name (Legal Business Name): MICHAEL L PARKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 OYSTER POINT RD STE 101
NEWPORT NEWS VA
23606-4570
US

IV. Provider business mailing address

680 OYSTER POINT RD
NEWPORT NEWS VA
23606-4570
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-4851
  • Fax: 757-686-0541
Mailing address:
  • Phone: 757-668-4851
  • Fax: 757-686-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110002534
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: