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General NPI Number Information
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NPI Number | 1568434017
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Entity Type | Individual
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Provider Name | GEORGE ANGELO LADIKOS PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 02/13/2021
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Provider Practice Location Address
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Address Line | 1721 TAUSIGG BLVD
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City | NORFOLK
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State | VA
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Zip | 23511-0000
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Country | US
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Telephone | 757-314-6258
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 CREEKS EDGE DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-6805
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Country | US
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Telephone | 757-496-2828
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1008625
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License Number State | VA
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