MEDICARE: PAUL M DERBER 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
1	207R00000X	Internal Medicine Physician	10179	NV
2	208M00000X	Hospitalist Physician	101241807	VA
3	207R00000X	Internal Medicine Physician	0101241807	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	179167	OTHER	VA	BCBS VA
3	689437	OTHER		SOUTHERN HEALTH

General Provider Information

NPI Number	:	1366446809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL M DERBER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7068
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23707-0068
Country	:	US
Telephone Number	:	757-686-3508
Fax Number	:	757-686-0541

Provider Business Practice Location Address
First Line	:	1168 FIRST COLONIAL RD
Second Line	:	STE 201
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2444
Country	:	US
Telephone Number	:	757-481-1113
Fax Number	:	757-496-3822

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/06/2011

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Directions to “ PAUL M DERBER M.D.” Practice Location

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