Healthcare Provider Details

I. General information

NPI: 1932336203
Provider Name (Legal Business Name): JAMES SYLVESTER EBERTOWSKI II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 08/15/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5424 DISCOVERY BLVD, BLDG B, STE 203
WILLAMSBURGH VA
23188
US

IV. Provider business mailing address

860 OMNI BLVD STE 128
NEWPORT NEWS VA
23606-4483
US

V. Phone/Fax

Practice location:
  • Phone: 757-345-6223
  • Fax:
Mailing address:
  • Phone: 757-964-8739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101248205
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number75616
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0061398
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: