Healthcare Provider Details

I. General information

NPI: 1588660880
Provider Name (Legal Business Name): RICHARD SCOTT ROSENBLUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 SHORE DR STE 200
VIRGINIA BEACH VA
23451-1498
US

IV. Provider business mailing address

2829 SHORE DR STE 200
VIRGINIA BEACH VA
23451-1498
US

V. Phone/Fax

Practice location:
  • Phone: 757-734-1000
  • Fax: 757-734-1001
Mailing address:
  • Phone: 757-734-1000
  • Fax: 757-734-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101225952
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: