Healthcare Provider Details

I. General information

NPI: 1174615447
Provider Name (Legal Business Name): NORFOLK PLASTIC SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 KEMPSVILLE CIR SUITE 300
NORFOLK VA
23502-3932
US

IV. Provider business mailing address

6161 KEMPSVILLE CIR SUITE 300
NORFOLK VA
23502-3932
US

V. Phone/Fax

Practice location:
  • Phone: 757-466-1000
  • Fax: 757-466-7788
Mailing address:
  • Phone: 757-466-1000
  • Fax: 757-466-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number0101056114
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number0101044977
License Number StateVA

VIII. Authorized Official

Name: MRS. CINDY L CREECH
Title or Position: BILLING COORDINATOR
Credential: CPC
Phone: 919-763-0123