Healthcare Provider Details

I. General information

NPI: 1235461757
Provider Name (Legal Business Name): CORY ARNOLD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4133 PERIDOT DR
VIRGINIA BEACH VA
23456-5807
US

IV. Provider business mailing address

246 OXFORD RD
MOYOCK NC
27958-8763
US

V. Phone/Fax

Practice location:
  • Phone: 757-286-8030
  • Fax:
Mailing address:
  • Phone: 757-286-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: