Healthcare Provider Details

I. General information

NPI: 1386696607
Provider Name (Legal Business Name): WINFIELD ANTHONY YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 LAKE JAMES DR STE C
VIRGINIA BEACH VA
23464-6779
US

IV. Provider business mailing address

1212 LAKE JAMES DR STE C
VIRGINIA BEACH VA
23464-6779
US

V. Phone/Fax

Practice location:
  • Phone: 757-523-4589
  • Fax: 757-523-8920
Mailing address:
  • Phone: 757-523-4589
  • Fax: 757-523-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101040247
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: