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General NPI Number Information
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NPI Number | 1528213931
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Entity Type | Organization
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Legal Business Name | DERJAN GROUP
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Dates
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Enumeration Date | 11/26/2008
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Last Update Date | 11/26/2008
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Provider Practice Location Address
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Address Line | 550 NORTH BATTLEFIELD
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3544
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Country | US
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Telephone | 757-831-3919
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Fax |
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Provider Business Mailing Address
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Address Line | 801 SHADOWBERRY CRST
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3544
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Country | US
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Telephone | 757-831-3919
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DEREK GRIFFIN
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Credential |
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Telephone | 757-831-3919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 305R00000X
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License Number State |
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