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General NPI Number Information
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NPI Number | 1649540980
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Entity Type | Organization
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Legal Business Name | ROAMINGMAC PLLC
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Dates
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Enumeration Date | 01/04/2012
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | 329 PHILLIP AVE
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-4461
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Country | US
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Telephone | 757-687-1900
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Fax | 757-687-1895
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Provider Business Mailing Address
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Address Line | 804 SCOTT NIXON MEMORIAL DR
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City | AUGUSTA
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State | GA
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Zip | 30907-2464
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Country | US
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Telephone | 800-394-4445
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Fax | 706-650-1034
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Authorized Official
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Title or Position | MANAGER
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Name | DOUG RICHARD MILLER
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Credential | DO
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Telephone | 757-312-4047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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