Healthcare Provider Details

I. General information

NPI: 1932167863
Provider Name (Legal Business Name): ORTHOPAEDIC ASSOCIATES OF VIRGINIA, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6275 E VIRGINIA BEACH BLVD SUITE 300
NORFOLK VA
23502-2851
US

IV. Provider business mailing address

6275 E VIRGINIA BEACH BLVD SUITE 300
NORFOLK VA
23502-2851
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-1688
  • Fax: 757-455-5865
Mailing address:
  • Phone: 757-461-1688
  • Fax: 757-455-5865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JANE SUMMERLIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 757-461-1688