Healthcare Provider Details

I. General information

NPI: 1649671926
Provider Name (Legal Business Name): KYLE RESENDES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR RALEIGH BUILDING, ROOM 304
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

6001 FITZHUGH AVE
RICHMOND VA
23226-2407
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-3397
  • Fax: 757-388-2885
Mailing address:
  • Phone: 434-851-1351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0116026941
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101262575
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: