Healthcare Provider Details

I. General information

NPI: 1780338947
Provider Name (Legal Business Name): OCEANFRONT PAIN MANAGEMENT AND SPORTS MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 LITTLE NECK RD 3300 NORTH BUILDING, SUITE 115
VIRGINIA BEACH VA
23452
US

IV. Provider business mailing address

101 MEDFORD CT
YORKTOWN VA
23693-0012
US

V. Phone/Fax

Practice location:
  • Phone: 757-500-2277
  • Fax:
Mailing address:
  • Phone: 732-331-9626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KINJAL B SOHAGIA
Title or Position: OWNER
Credential: MD
Phone: 757-500-2277