Healthcare Provider Details

I. General information

NPI: 1952866659
Provider Name (Legal Business Name): LORRIN AVERY HERBERT CFO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 INVESTORS PL STE 104
VIRGINIA BEACH VA
23452-1171
US

IV. Provider business mailing address

404 INVESTORS PL STE 104
VIRGINIA BEACH VA
23452-1171
US

V. Phone/Fax

Practice location:
  • Phone: 757-275-8050
  • Fax: 888-600-5328
Mailing address:
  • Phone: 757-275-8050
  • Fax: 888-600-5328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCFO04815
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: