Healthcare Provider Details

I. General information

NPI: 1588620991
Provider Name (Legal Business Name): T. ONSANIT, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 INDEPENDENCE BLVD 204
VIRGINIA BEACH VA
23455-5500
US

IV. Provider business mailing address

1020 INDEPENDENCE BLVD 204
VIRGINIA BEACH VA
23455-5500
US

V. Phone/Fax

Practice location:
  • Phone: 757-464-5642
  • Fax: 757-363-1973
Mailing address:
  • Phone: 757-464-5642
  • Fax: 757-363-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number0101027846
License Number StateVA

VIII. Authorized Official

Name: DR. TAWACHAI ONSANIT
Title or Position: PRESIDENT
Credential: MD
Phone: 757-464-5642