Healthcare Provider Details

I. General information

NPI: 1326181413
Provider Name (Legal Business Name): BON SECOURS DEPAUL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 KINGSLEY LN
NORFOLK VA
23505-4602
US

IV. Provider business mailing address

150 KINGSLEY LN
NORFOLK VA
23505-4602
US

V. Phone/Fax

Practice location:
  • Phone: 757-889-2300
  • Fax: 757-889-5019
Mailing address:
  • Phone: 757-889-2300
  • Fax: 757-889-5019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL K KERNER
Title or Position: CEO
Credential:
Phone: 757-673-5929