Healthcare Provider Details

I. General information

NPI: 1972562056
Provider Name (Legal Business Name): STEPHEN EDWARD PLOTNICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 VIRGINIA BEACH BLVD SUITE 300
VIRGINIA BEACH VA
23452-4445
US

IV. Provider business mailing address

3500 VIRGINIA BEACH BLVD SUITE 300
VIRGINIA BEACH VA
23452-4445
US

V. Phone/Fax

Practice location:
  • Phone: 757-412-1048
  • Fax: 757-412-1483
Mailing address:
  • Phone: 757-412-1048
  • Fax: 757-412-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberVA0101049622
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: