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General NPI Number Information
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NPI Number | 1770555781
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Entity Type | Individual
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Provider Name | HARRY ERVIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 01/04/2019
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Provider Practice Location Address
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Address Line | 2800 GODWIN BLVD
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City | SUFFOLK
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State | VA
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Zip | 23434-8038
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Country | US
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Telephone | 757-983-8247
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Fax |
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Provider Business Mailing Address
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Address Line | 3003 N JAMES DR
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City | SUFFOLK
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State | VA
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Zip | 23435-3352
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Country | US
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Telephone | 757-761-7561
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 40365
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License Number State | CO
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