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NPI Code Detail

MEDICARE: PETER O. KWONG M.D.

MEDICARE: PETER O. KWONG M.D.
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
1208800000XUrology Physician0101232710VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1196919OTHERANTHEM BC/BS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3245559OTHERVAANTHEM BC BS
458060OTHERVASENTARA HEALTHCARE

General Provider Information

NPI Number : 1306824495
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER O. KWONG M.D.
Provider Business Mailing Address
First Line : 225 CLEARFIELD AVE
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-1815
Country : US
Telephone Number : 757-452-3480
Fax Number : 757-452-3482
Provider Business Practice Location Address
First Line : 225 CLEARFIELD AVE
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-1815
Country : US
Telephone Number : 757-452-3480
Fax Number : 757-452-3482
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2006
Last Update Date : 11/27/2013

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Directions to “ PETER O. KWONG M.D.” Practice Location

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