Healthcare Provider Details

I. General information

NPI: 1942371471
Provider Name (Legal Business Name): ORTHOPAEDIC ASSOCIATES OF VIRGINIA, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 GLENN MITCHELL DR SUITE 206
VIRGINIA BEACH VA
23456
US

IV. Provider business mailing address

6275 E VIRGINIA BEACH BLVD SUITE 300
NORFOLK VA
23502-2851
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-1688
  • Fax: 757-455-5865
Mailing address:
  • Phone: 757-461-1688
  • Fax: 757-455-5865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JANE SUMMERLIN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 757-893-1700