Healthcare Provider Details

I. General information

NPI: 1255818001
Provider Name (Legal Business Name): SIMRAT KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920A BRIDGE RD STE 202
SUFFOLK VA
23435-1117
US

IV. Provider business mailing address

3920A BRIDGE RD STE 202
SUFFOLK VA
23435-1117
US

V. Phone/Fax

Practice location:
  • Phone: 757-983-0330
  • Fax: 757-431-7788
Mailing address:
  • Phone: 757-983-0330
  • Fax: 757-431-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57.245593
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101287904
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: