Healthcare Provider Details

I. General information

NPI: 1275548695
Provider Name (Legal Business Name): LAMBROS KONSTANTINOS VIENNAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 RIVERVIEW AVE STE 400
NORFOLK VA
23510-1065
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 757-252-1700
  • Fax: 757-431-7775
Mailing address:
  • Phone: 614-293-8566
  • Fax: 614-293-3381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD47480
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number0101245217
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35144123
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: