MEDICARE: DR. HUMBERTO F PAVON 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	0101024987	VA
2	207RN0300X	Nephrology Physician	0101024987	VA

General Provider Information

NPI Number	:	1588661219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUMBERTO F PAVON M.D.

Provider Business Mailing Address
First Line	:	5700 LAKE WRIGHT DR
Second Line	:	SUITE 101
City	:	NORFOLK
State	:	VA
Zip	:	23502-1859
Country	:	US
Telephone Number	:	757-502-4840
Fax Number	:	757-502-4841

Provider Business Practice Location Address
First Line	:	5700 LAKE WRIGHT DR
Second Line	:	SUITE 101
City	:	NORFOLK
State	:	VA
Zip	:	23502-1859
Country	:	US
Telephone Number	:	757-502-4840
Fax Number	:	757-502-4841

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	12/08/2009

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