Healthcare Provider Details

I. General information

NPI: 1245464742
Provider Name (Legal Business Name): BO ZHAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SENTARA CIR STE 203
WILLIAMSBURG VA
23188-5727
US

IV. Provider business mailing address

6350 CENTER DR STE 200
NORFOLK VA
23502-4107
US

V. Phone/Fax

Practice location:
  • Phone: 757-229-2236
  • Fax: 757-221-0409
Mailing address:
  • Phone: 757-905-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35. 126433
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0101271785
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: