Healthcare Provider Details

I. General information

NPI: 1437765971
Provider Name (Legal Business Name): MORGAN ELIESE CLOUGH MARTIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 GLENN MITCHELL DR STE 102
VIRGINIA BEACH VA
23456-0019
US

IV. Provider business mailing address

6350 CENTER DR STE 200
NORFOLK VA
23502-4107
US

V. Phone/Fax

Practice location:
  • Phone: 757-368-0437
  • Fax: 757-368-0492
Mailing address:
  • Phone: 757-213-5700
  • Fax: 757-213-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9117656
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110007260
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: