Healthcare Provider Details

I. General information

NPI: 1659720589
Provider Name (Legal Business Name): LAURA BAGDONAITE BEJARANO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4665 SOUTH BLVD
VIRGINIA BEACH VA
23452-1055
US

IV. Provider business mailing address

4665 SOUTH BLVD
VIRGINIA BEACH VA
23452-1055
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-0050
  • Fax:
Mailing address:
  • Phone: 757-461-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number0101269684
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: