MEDICARE: DR. GEORGE KELLY HEUSER MD

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	0101040554	VA

General Provider Information

NPI Number	:	1639213192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE KELLY HEUSER MD

Provider Business Mailing Address
First Line	:	1744 JACK FROST RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-3221
Country	:	US
Telephone Number	:	757-464-2330
Fax Number	:	757-552-7108

Provider Business Practice Location Address
First Line	:	1744 JACK FROST RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-3221
Country	:	US
Telephone Number	:	757-464-2330
Fax Number	:	757-552-7108

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

Provider Enumeration Date	:	02/17/2007
Last Update Date	:	07/08/2007

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