Healthcare Provider Details

I. General information

NPI: 1780121962
Provider Name (Legal Business Name): MARYVIEW HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7185 HARBOUR TOWNE PKWY SUITE 105
SUFFOLK VA
23435-3796
US

IV. Provider business mailing address

7185 HARBOUR TOWNE PKWY SUITE 105
SUFFOLK VA
23435-3796
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-2331
  • Fax: 757-686-1442
Mailing address:
  • Phone: 757-934-2331
  • Fax: 757-686-1442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN SMITH
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 757-215-2784