Healthcare Provider Details

I. General information

NPI: 1831173665
Provider Name (Legal Business Name): ANANT S DAMLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5818 HARBOUR VIEW BLVD STE 240
SUFFOLK VA
23435-3315
US

IV. Provider business mailing address

5818 HARBOUR VIEW BLVD STE 240
SUFFOLK VA
23435-3315
US

V. Phone/Fax

Practice location:
  • Phone: 757-483-6100
  • Fax: 757-483-2203
Mailing address:
  • Phone: 757-483-6100
  • Fax: 757-483-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number101221471
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: