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General NPI Number Information
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NPI Number | 1023050465
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Entity Type | Organization
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Legal Business Name | SOUTHERN SURGICAL ASSOCIATES, PLLC T/A NORFOLK SURGICAL GROUP
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 6160 KEMPSVILLE CIR SUITE 101B
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City | NORFOLK
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State | VA
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Zip | 23502-3933
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Country | US
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Telephone | 757-461-2515
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Fax | 757-466-1104
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Provider Business Mailing Address
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Address Line | 6160 KEMPSVILLE CIR SUITE 101B
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City | NORFOLK
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State | VA
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Zip | 23502-3933
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Country | US
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Telephone | 757-461-2515
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Fax | 757-466-1104
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Authorized Official
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Title or Position | MANAGING PHYSICIAN
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Name | DR. STEPHEN D WOHLGEMUTH
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Credential | M.D.
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Telephone | 757-461-2515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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