Healthcare Provider Details

I. General information

NPI: 1821017088
Provider Name (Legal Business Name): HEIDI AMANDA KULBERG M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 WHITECHAPEL DR
VIRGINIA BEACH VA
23455-6447
US

IV. Provider business mailing address

4509 WHITECHAPEL DR
VIRGINIA BEACH VA
23455-6447
US

V. Phone/Fax

Practice location:
  • Phone: 757-460-4655
  • Fax: 757-460-7744
Mailing address:
  • Phone: 757-460-4655
  • Fax: 757-460-7744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number0101238091
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: