Healthcare Provider Details

I. General information

NPI: 1740743053
Provider Name (Legal Business Name): JEREMY OWENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4534 BONNEY RD STE B
VIRGINIA BEACH VA
23462-3873
US

IV. Provider business mailing address

1828 DUKE OF NORFOLK QUAY
VIRGINIA BEACH VA
23454-1106
US

V. Phone/Fax

Practice location:
  • Phone: 757-499-4101
  • Fax: 757-260-7352
Mailing address:
  • Phone: 757-572-6052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number0101282801
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: