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General NPI Number Information
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NPI Number | 1386725661
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Entity Type | Organization
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Legal Business Name | ATLANTIC UROLOGY LLC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 681 BATTLEFIELD BLVD N STE H
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4951
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Country | US
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Telephone | 757-549-8059
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Fax | 757-436-3498
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Provider Business Mailing Address
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Address Line | 681 BATTLEFIELD BLVD N STE H
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4951
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Country | US
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Telephone | 757-549-8059
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Fax | 757-436-3498
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID MICHAEL LUSTIG
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Credential | M.D.
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Telephone | 757-549-8059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 0101024391
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License Number State | VA
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