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General NPI Number Information
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NPI Number | 1821259409
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Entity Type | Organization
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Legal Business Name | PNMC
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 1115 PEDDARS WAY
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City | NORFOLK
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State | VA
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Zip | 23505-1429
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Country | US
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Telephone | 757-953-8726
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Fax |
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Provider Business Mailing Address
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Address Line | 1721 TAUSSIG BLVD
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City | NORFOLK
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State | VA
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Zip | 23511
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Country | US
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Telephone | 757-953-8726
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Fax |
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Authorized Official
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Title or Position | IDC
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Name | MR. ERIC M BLAKE
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Credential |
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Telephone | 757-953-8726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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