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General NPI Number Information
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NPI Number | 1255325254
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Entity Type | Individual
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Provider Name | KERRY C PREWITT M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/06/2005
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Last Update Date | 08/09/2025
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Provider Practice Location Address
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Address Line | 113 BULIFANTS BLVD STE A
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-5719
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Country | US
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Telephone | 804-520-1764
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Fax |
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Provider Business Mailing Address
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Address Line | 445 CHARLES H DIMMOCK PKWY STE 100
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-2990
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Country | US
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Telephone | 804-520-1764
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | D0057329
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | D0057329
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 0101041337
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 0101041337
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License Number State | VA
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