Healthcare Provider Details

I. General information

NPI: 1346238342
Provider Name (Legal Business Name): NANCY M. KHARDORI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY MISRI M.D.

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 FAIRFAX AVE SUITE 572
NORFOLK VA
23507-1914
US

IV. Provider business mailing address

PO BOX 936
NORFOLK VA
23501-0936
US

V. Phone/Fax

Practice location:
  • Phone: 757-446-8999
  • Fax: 757-446-7922
Mailing address:
  • Phone: 757-446-8999
  • Fax: 757-446-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101249621
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: