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General NPI Number Information
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NPI Number | 1487800876
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Entity Type | Organization
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Legal Business Name | HARBOUR SPORTS MEDICINE
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 5818 HARBOUR VIEW BLVD # D SUITE 150
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City | SUFFOLK
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State | VA
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Zip | 23435-3315
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Country | US
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Telephone | 757-215-1400
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Fax | 757-215-1410
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Provider Business Mailing Address
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Address Line | 5818 HARBOUR VIEW BLVD # D SUITE 150
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City | SUFFOLK
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State | VA
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Zip | 23435-3315
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Country | US
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Telephone | 757-215-1400
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Fax | 757-215-1410
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Authorized Official
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Title or Position | PRESIDENT, OWNER
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Name | DR. ARTHUR W WARDELL
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Credential | M.D.
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Telephone | 757-215-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 01010321
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 01010321
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License Number State | VA
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