Healthcare Provider Details

I. General information

NPI: 1215199757
Provider Name (Legal Business Name): REBECCA A CARMODY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 MOWBRAY ARCH SUITE 203
NORFOLK VA
23507-2219
US

IV. Provider business mailing address

PO BOX 1980
NORFOLK VA
23501-1980
US

V. Phone/Fax

Practice location:
  • Phone: 757-446-6190
  • Fax:
Mailing address:
  • Phone: 757-446-6190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116019598
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: