Healthcare Provider Details

I. General information

NPI: 1790715506
Provider Name (Legal Business Name): SOUTHERN SURGICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 HIGH ST SUITE 2F
PORTSMOUTH VA
23707-3213
US

IV. Provider business mailing address

3640 HIGH ST SUITE 2F
PORTSMOUTH VA
23707-3213
US

V. Phone/Fax

Practice location:
  • Phone: 757-397-2383
  • Fax: 757-397-5201
Mailing address:
  • Phone: 757-397-2383
  • Fax: 757-397-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VASKEN KEVORK TENEKJIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 757-397-2383