Healthcare Provider Details

I. General information

NPI: 1265474795
Provider Name (Legal Business Name): KAMAL R CHEMALI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR STE 8630C
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

600 GRESHAM DR STE 8630C
NORFOLK VA
23507-1904
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-6105
  • Fax: 757-388-6106
Mailing address:
  • Phone: 757-388-6105
  • Fax: 757-388-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35074649
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101250018
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number2704
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: