Healthcare Provider Details

I. General information

NPI: 1881730083
Provider Name (Legal Business Name): KEVIN B BOUNDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 COLONIAL MEDICAL CT
VIRGINIA BEACH VA
23454-3034
US

IV. Provider business mailing address

1815 COLONIAL MEDICAL CT
VIRGINIA BEACH VA
23454-3034
US

V. Phone/Fax

Practice location:
  • Phone: 757-496-7373
  • Fax: 757-496-7336
Mailing address:
  • Phone: 757-496-7373
  • Fax: 757-496-7336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101043805
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: