Healthcare Provider Details

I. General information

NPI: 1689670283
Provider Name (Legal Business Name): WILLIAM PRESTON MAGEE JR. DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W BRAMBLETON AVE STE 103
NORFOLK VA
23510-1115
US

IV. Provider business mailing address

400 W BRAMBLETON AVE STE 103
NORFOLK VA
23510-1115
US

V. Phone/Fax

Practice location:
  • Phone: 757-627-6700
  • Fax: 757-627-8973
Mailing address:
  • Phone: 757-627-6700
  • Fax: 757-627-8973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101025282
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: