=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033191077
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAPHNE MICHELLE LENOX MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2005
-----------------------------------------------------
Last Update Date | 01/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 134 BUSINESS PARK DR
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23462-6523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-473-0055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 203 WESTOVER AVE 301
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23507-2313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-493-3978
-----------------------------------------------------
Fax | 601-703-3264
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 18515
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------