Healthcare Provider Details

I. General information

NPI: 1396056982
Provider Name (Legal Business Name): FORT NORFOLK PLAZA MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 RIVERVIEW AVE STE 500
NORFOLK VA
23510-1066
US

IV. Provider business mailing address

301 RIVERVIEW AVENUE SUTIE 500
NORFOLK VA
23510-1064
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

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