Healthcare Provider Details

I. General information

NPI: 1558588798
Provider Name (Legal Business Name): EMMELINE CENIZAL GASINK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 WILLIAMSBURG LANDING DR
WILLIAMSBURG VA
23185-3779
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD SUITE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 757-565-6525
  • Fax: 757-565-6551
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101239351
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: