Healthcare Provider Details

I. General information

NPI: 1699001081
Provider Name (Legal Business Name): FORT NORFOLK PLAZA MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 RIVERVIEW AVENUE SUITE 500
NORFOLK VA
23510-1064
US

IV. Provider business mailing address

301 RIVERVIEW AVENUE SUITE 500
NORFOLK VA
23510-1064
US

V. Phone/Fax

Practice location:
  • Phone: 757-624-1785
  • Fax: 757-624-1759
Mailing address:
  • Phone: 757-624-1785
  • Fax: 757-624-1759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH H NEWBY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 757-624-1785