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General NPI Number Information
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NPI Number | 1396353181
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Entity Type | Individual
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Provider Name | LEVAN GAKHOKIDZE MD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2020
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 3640 HIGH ST STE 2G
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City | PORTSMOUTH
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State | VA
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Zip | 23707-3213
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Country | US
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Telephone | 757-977-1110
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Fax | 757-977-1107
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Provider Business Mailing Address
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Address Line | 6261 E VIRGINIA BEACH BLVD STE 201
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City | NORFOLK
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State | VA
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Zip | 23502-2964
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Country | US
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Telephone | 757-466-9288
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 0101283991
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License Number State | VA
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