Healthcare Provider Details

I. General information

NPI: 1053396093
Provider Name (Legal Business Name): GEORGE MARSHALL KEMP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 FIRST COLONIAL RD SUITE 202
VIRGINIA BEACH VA
23454-2418
US

IV. Provider business mailing address

1120 FIRST COLONIAL RD SUITE 202
VIRGINIA BEACH VA
23454-2418
US

V. Phone/Fax

Practice location:
  • Phone: 757-481-0327
  • Fax: 757-481-6731
Mailing address:
  • Phone: 757-481-0327
  • Fax: 757-481-6731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101035376
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: