Healthcare Provider Details

I. General information

NPI: 1942616602
Provider Name (Legal Business Name): VIRGINIA BEACH MEDICAL ASSOCIATES, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 FIRST COLONIAL RD
VIRGINIA BEACH VA
23454-3002
US

IV. Provider business mailing address

PO BOX 5508
VIRGINIA BEACH VA
23471-0508
US

V. Phone/Fax

Practice location:
  • Phone: 757-340-3489
  • Fax: 757-340-4278
Mailing address:
  • Phone: 757-340-3489
  • Fax: 757-340-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL CHUPKA
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D.
Phone: 757-340-3489