=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790810455
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIRGINIA NEUROLOGY AND SLEEP CENTER PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2007
-----------------------------------------------------
Last Update Date | 09/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 637 KINGSBOROUGH SQ STE E
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-4944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-778-2247
-----------------------------------------------------
Fax | 833-471-4175
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 637 KINGSBOROUGH SQ SUITE E
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-4944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-410-2804
-----------------------------------------------------
Fax | 757-410-2813
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | KATHY GLENN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-266-5917
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------