Healthcare Provider Details

I. General information

NPI: 1134534167
Provider Name (Legal Business Name): KHYATI APOORVA TALATI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2014
Last Update Date: 07/13/2024
Certification Date: 07/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 E LITTLE CREEK RD
NORFOLK VA
23518-4205
US

IV. Provider business mailing address

PO BOX 7068
PORTSMOUTH VA
23707-0068
US

V. Phone/Fax

Practice location:
  • Phone: 757-583-2181
  • Fax: 757-480-6482
Mailing address:
  • Phone: 757-686-3516
  • Fax: 757-686-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036141546
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101265551
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125065653
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: