Healthcare Provider Details

I. General information

NPI: 1518901339
Provider Name (Legal Business Name): JILL T FLOOD MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 FIRST COLONIAL RD SUITE 202
VIRGINIA BEACH VA
23451
US

IV. Provider business mailing address

844 FIRST COLONIAL RD SUITE 202
VIRGINIA BEACH VA
23451
US

V. Phone/Fax

Practice location:
  • Phone: 757-428-0002
  • Fax: 757-428-4555
Mailing address:
  • Phone: 757-428-0002
  • Fax: 757-428-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT B MCCULLOUGH III
Title or Position: OFFICE MANAGER
Credential:
Phone: 757-428-0002