Healthcare Provider Details

I. General information

NPI: 1851391478
Provider Name (Legal Business Name): GEORGE H AMBERMAN III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 INDEPENDENCE BLVD
VIRGINIA BEACH VA
23455-5545
US

IV. Provider business mailing address

1147 INDEPENDENCE BLVD
VIRGINIA BEACH VA
23455-5545
US

V. Phone/Fax

Practice location:
  • Phone: 757-460-1207
  • Fax: 757-460-2136
Mailing address:
  • Phone: 757-460-1207
  • Fax: 757-460-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number0101035205
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: