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General NPI Number Information
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NPI Number | 1598703498
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN SURGICAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 840 FIRST COLONIAL RD SUITE 102
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-6106
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Country | US
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Telephone | 757-422-2212
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Fax | 757-422-9177
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Provider Business Mailing Address
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Address Line | 840 FIRST COLONIAL RD SUITE 102
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-6106
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Country | US
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Telephone | 757-422-2212
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Fax | 757-422-9177
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAURENCE WILLIAM ENDERSON III
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Credential | M.D.
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Telephone | 757-422-2212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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