Healthcare Provider Details

I. General information

NPI: 1528117801
Provider Name (Legal Business Name): IRA LEDERMAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7312 GRANBY ST
NORFOLK VA
23505-3442
US

IV. Provider business mailing address

7312 GRANBY ST
NORFOLK VA
23505-3442
US

V. Phone/Fax

Practice location:
  • Phone: 757-583-5826
  • Fax: 757-588-2712
Mailing address:
  • Phone: 757-583-5826
  • Fax: 757-588-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number0101016600
License Number StateVA

VIII. Authorized Official

Name: PAM HOPKINS
Title or Position: BILLING ADMINISTRATOR
Credential:
Phone: 757-583-5826