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General NPI Number Information
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NPI Number | 1841315058
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Entity Type | Organization
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Legal Business Name | HAMPTON ROADS NEPHROLOGY ASSOCIATES
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 704 THIMBLE SHOALS BLVD SUITE 500-B
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4544
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Country | US
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Telephone | 757-599-3436
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Fax |
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Provider Business Mailing Address
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Address Line | 860 OMNI BLVD SUITE 303
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4430
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Country | US
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Telephone | 757-232-8777
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Fax | 757-232-8866
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | DIANE H. HAWKINS
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Credential |
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Telephone | 757-232-8769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101046873
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License Number State | VA
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