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NPI Code Detail

MEDICARE: MARY IMMACULATE HOSPITAL

MEDICARE: MARY IMMACULATE HOSPITAL
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
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1093762361
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARY IMMACULATE HOSPITAL
Provider Business Mailing Address
First Line : 2 BERNARDINE DR
Second Line :
City : NEWPORT NEWS
State : VA
Zip : 23602-4404
Country : US
Telephone Number : 757-886-6000
Fax Number : 757-886-6069
Provider Business Practice Location Address
First Line : 2 BERNARDINE DR
Second Line :
City : NEWPORT NEWS
State : VA
Zip : 23602-4404
Country : US
Telephone Number : 757-886-6000
Fax Number : 757-886-6069
Authorized Official
Title or Position : EVP/ADMINISTRATOR
Name : PATRICIA L ROBERTSON
Credential :
Telephone Number : 757-886-6758
Provider Enumeration Date : 05/30/2006
Last Update Date : 05/27/2009

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Directions to “MARY IMMACULATE HOSPITAL ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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