Healthcare Provider Details

I. General information

NPI: 1073781878
Provider Name (Legal Business Name): VALBONA KANAREK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 REDGATE AVE
NORFOLK VA
23507-1515
US

IV. Provider business mailing address

811 REDGATE AVE POST OFFICE BOX 11049
NORFOLK VA
23507-1515
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7007
  • Fax: 757-668-8658
Mailing address:
  • Phone: 757-668-7007
  • Fax: 757-668-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number0101253325
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA08653200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: