Healthcare Provider Details

I. General information

NPI: 1770527400
Provider Name (Legal Business Name): GYNECOLOGY ASSOCIATES LTD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 TIDEWATER DR.
NORFOLK VI
23509
US

IV. Provider business mailing address

PO BOX 7520
NORFOLK VA
23509
US

V. Phone/Fax

Practice location:
  • Phone: 757-627-0241
  • Fax: 757-622-8898
Mailing address:
  • Phone: 757-627-0241
  • Fax: 757-622-8898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ABRAHAM S ANDERSON
Title or Position: OWNER
Credential: MD
Phone: 757-627-0241