Healthcare Provider Details

I. General information

NPI: 1225564495
Provider Name (Legal Business Name): MICHAEL JAMES PIENTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR STE 8600
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

600 GRESHAM DR STE 8600
NORFOLK VA
23507-1904
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-6005
  • Fax: 757-388-6006
Mailing address:
  • Phone: 757-388-6005
  • Fax: 757-388-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301112089
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number0101285834
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: