MEDICARE: EASTERN VIRGINIA MEDICAL SCHOOL

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	282N00000X	General Acute Care Hospital	VA0101257244	VA

General Provider Information

NPI Number	:	1578940268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN VIRGINIA MEDICAL SCHOOL

Provider Business Mailing Address
First Line	:	PO BOX 1980
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23501-1980
Country	:	US
Telephone Number	:	757-446-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	714 WOODIS AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-1026
Country	:	US
Telephone Number	:	757-446-5600
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, RADIOLOGY RESIDENCY PROGR
Name	:	DR. LESTER JOHNSON
Credential	:	MD/PHD
Telephone Number	:	757-446-5600

Provider Enumeration Date	:	05/01/2015
Last Update Date	:	05/01/2015

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