Healthcare Provider Details

I. General information

NPI: 1942201504
Provider Name (Legal Business Name): NELSON MARC KARP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 S INDEPENDENCE BLVD
VIRGINIA BEACH VA
23452-1106
US

IV. Provider business mailing address

460 S INDEPENDENCE BLVD
VIRGINIA BEACH VA
23452-1106
US

V. Phone/Fax

Practice location:
  • Phone: 757-497-3439
  • Fax: 757-499-8702
Mailing address:
  • Phone: 757-497-3439
  • Fax: 757-499-8702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101034323
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: