Healthcare Provider Details

I. General information

NPI: 1720357247
Provider Name (Legal Business Name): HAMPTON ROADS ORTHOPAEDIC & SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5335 DISCOVERY PARK BLVD STE B
WILLIAMSBURG VA
23188-2696
US

IV. Provider business mailing address

730 THIMBLE SHOALS BLVD STE 130
NEWPORT NEWS VA
23606-4562
US

V. Phone/Fax

Practice location:
  • Phone: 757-253-0603
  • Fax: 757-585-7645
Mailing address:
  • Phone: 757-873-1554
  • Fax: 757-873-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WENDY JACKSON
Title or Position: CHIEF INFORMATION OFFICER
Credential:
Phone: 757-873-1554