Healthcare Provider Details

I. General information

NPI: 1851392161
Provider Name (Legal Business Name): L.E.A. LUMSDEN EUBANK ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 INDEPENDENCE BLVD.
VIRGINIA BEACH VA
23455
US

IV. Provider business mailing address

1147 INDEPENDENCE BLVD.
VIRGINIA BEACH VA
23455
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 TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: LIZ M WIRTH
Title or Position: ACCTS MGR
Credential:
Phone: 757-460-1207