Healthcare Provider Details

I. General information

NPI: 1700844016
Provider Name (Legal Business Name): LAURA ALOIS CHARETTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 CONCERT DR SUITE 202
VIRGINIA BEACH VA
23456-8082
US

IV. Provider business mailing address

917 GREAT MARSH AVE
CHESAPEAKE VA
23320-0682
US

V. Phone/Fax

Practice location:
  • Phone: 757-453-6711
  • Fax: 757-301-6496
Mailing address:
  • Phone: 757-548-0953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101046939
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: