Healthcare Provider Details

I. General information

NPI: 1386847333
Provider Name (Legal Business Name): MICHELLE KATHLEEN BOZARTH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE KATHLEEN GEE PA

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 WARWICK BLVD SUITE 410
NEWPORT NEWS VA
23601-2344
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD SUITE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 757-534-5200
  • Fax: 757-534-5830
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110002536
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: