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General NPI Number Information
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NPI Number | 1013986579
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Entity Type | Organization
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Legal Business Name | HAMPTON ROADS MEDICAL SPECIALISTS PC
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 02/21/2013
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Provider Practice Location Address
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Address Line | 2131 S BONITO WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-1659
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Country | US
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Telephone | 208-489-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 26 TOWN CENTER WAY # 704
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City | HAMPTON
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State | VA
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Zip | 23666-1999
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Country | US
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Telephone | 757-771-8049
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Fax | 757-851-1285
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN L GREEN
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Credential | MD
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Telephone | 757-869-9922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 0101028335
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License Number State | VA
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