Healthcare Provider Details

I. General information

NPI: 1235103714
Provider Name (Legal Business Name): ALAN R KUNKEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 E LITTLE CREEK RD
NORFOLK VA
23518-4205
US

IV. Provider business mailing address

PO BOX 7068
PORTSMOUTH VA
23707-0068
US

V. Phone/Fax

Practice location:
  • Phone: 757-583-2181
  • Fax: 757-480-6482
Mailing address:
  • Phone: 757-686-3542
  • Fax: 757-686-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102050042
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: