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General NPI Number Information
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NPI Number | 1275586240
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Entity Type | Organization
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Legal Business Name | NORTHERN NECK SURGICAL SERVICES
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 95 HARRIS RD BUILDING 1
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City | KILMARNOCK
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State | VA
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Zip | 22482-3845
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Country | US
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Telephone | 804-435-1608
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Fax | 804-435-3872
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Provider Business Mailing Address
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Address Line | PO BOX 1955
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City | KILMARNOCK
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State | VA
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Zip | 22482-1955
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Country | US
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Telephone | 804-435-1608
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Fax | 804-435-3872
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN J OLTERMANN
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Credential | M.D.
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Telephone | 804-435-1608
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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 | 0101039744
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License Number State | VA
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