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General NPI Number Information
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NPI Number | 1467050740
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Entity Type | Organization
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Legal Business Name | SHALLORTHO
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Dates
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Enumeration Date | 10/09/2020
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 637 KINGSBOROUGH SQ STE D
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4944
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Country | US
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Telephone | 757-762-3582
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Fax | 757-664-9930
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Provider Business Mailing Address
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Address Line | 4545 COMMERCE ST UNIT 2606
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3283
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Country | US
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Telephone | 757-762-3582
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. LAWRENCE SHALL
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Credential | MD
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Telephone | 757-762-3582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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