MEDICARE: FORT NORFOLK PLAZA MEDICAL ASSOCIATES, LLC

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	VAA103551	OTHER		GROUP PTAN

General Provider Information

NPI Number	:	1194899534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT NORFOLK PLAZA MEDICAL ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	930 MAJESTIC AVE
Second Line	:	SUITE 220
City	:	NORFOLK
State	:	VA
Zip	:	23504-4055
Country	:	US
Telephone Number	:	757-627-6892
Fax Number	:	757-627-5809

Provider Business Practice Location Address
First Line	:	930 MAJESTIC AVE
Second Line	:	SUITE 220
City	:	NORFOLK
State	:	VA
Zip	:	23504-4055
Country	:	US
Telephone Number	:	757-627-6892
Fax Number	:	757-627-5809

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES EDWARD NEWBY II
Credential	:	M.D.
Telephone Number	:	757-627-6892

Provider Enumeration Date	:	11/18/2006
Last Update Date	:	01/05/2011

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Directions to “FORT NORFOLK PLAZA MEDICAL ASSOCIATES, LLC ” Practice Location

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