Healthcare Provider Details

I. General information

NPI: 1780995787
Provider Name (Legal Business Name): VINCENT L ACKERMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 MORRIS ST
NORFOLK VA
23511-2808
US

IV. Provider business mailing address

PSC 819 BOX 4340
FPO AE
09645-0044
US

V. Phone/Fax

Practice location:
  • Phone: 619-437-2860
  • Fax:
Mailing address:
  • Phone: 240-245-4659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0845
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: