MEDICARE: RENNY JOE STOCUM P.A.

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	363A00000X	Physician Assistant	0110007831	VA
2	363A00000X	Physician Assistant	007239	NY

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

General Provider Information

NPI Number	:	1700096583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENNY JOE STOCUM P.A.

Provider Business Mailing Address
First Line	:	4000 COLISEUM DR STE 200A
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-5975
Country	:	US
Telephone Number	:	757-736-1520
Fax Number	:

Provider Business Practice Location Address
First Line	:	5589 GREENWICH RD STE 100
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6565
Country	:	US
Telephone Number	:	888-628-8272
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	12/16/2025

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