Healthcare Provider Details

I. General information

NPI: 1598743692
Provider Name (Legal Business Name): KURT A. MCCAMMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CLEARFIELD AVE
VIRGINIA BEACH VA
23462-1815
US

IV. Provider business mailing address

225 CLEARFIELD AVE
VIRGINIA BEACH VA
23462-1815
US

V. Phone/Fax

Practice location:
  • Phone: 757-457-5110
  • Fax: 757-466-3411
Mailing address:
  • Phone: 757-457-5110
  • Fax: 757-466-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101057382
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number0101057382
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: