Healthcare Provider Details

I. General information

NPI: 1881639375
Provider Name (Legal Business Name): SERGEY ZHITAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N LYNNHAVEN RD SUITE 100
VIRGINIA BEACH VA
23452-7523
US

IV. Provider business mailing address

615 ELSINORE PL STE 200
CINCINNATI OH
45202-1457
US

V. Phone/Fax

Practice location:
  • Phone: 757-264-9957
  • Fax: 757-963-0444
Mailing address:
  • Phone: 513-834-7063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number0101230485
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: