Healthcare Provider Details

I. General information

NPI: 1528245347
Provider Name (Legal Business Name): TATIANA BORISOVNA KECK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TATIANA BORISOVNA MOLYAKO MD

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date: 06/10/2025
Reactivation Date: 07/21/2025

III. Provider practice location address

844 KEMPSVILLE RD STE 103B
NORFOLK VA
23502-3927
US

IV. Provider business mailing address

933 FIRST COLONIAL RD STE 100
VIRGINIA BEACH VA
23454-3172
US

V. Phone/Fax

Practice location:
  • Phone: 757-261-0200
  • Fax:
Mailing address:
  • Phone: 757-491-7359
  • Fax: 757-491-9359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number0101255588
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number101255588
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51231
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: