MEDICARE: GEORGE MARSHALL KEMP MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	0101035376	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	331101	OTHER	VA	BLUECROSSBLUESHIELD

General Provider Information

NPI Number	:	1053396093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE MARSHALL KEMP MD

Provider Business Mailing Address
First Line	:	1120 FIRST COLONIAL RD
Second Line	:	SUITE 202
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2418
Country	:	US
Telephone Number	:	757-481-0327
Fax Number	:	757-481-6731

Provider Business Practice Location Address
First Line	:	1120 FIRST COLONIAL RD
Second Line	:	SUITE 202
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2418
Country	:	US
Telephone Number	:	757-481-0327
Fax Number	:	757-481-6731

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	03/13/2008

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