Provider Demographics
NPI:1053326777
Name:VERDI, VINCENT JAMES (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:JAMES
Last Name:VERDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3921 GRANBY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-1201
Mailing Address - Country:US
Mailing Address - Phone:757-583-5826
Mailing Address - Fax:757-588-2712
Practice Address - Street 1:3921 GRANBY ST
Practice Address - Street 2:SUITE A
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504
Practice Address - Country:US
Practice Address - Phone:757-583-5826
Practice Address - Fax:757-588-2712
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101234127207W00000X
NC200300209207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010134510Medicaid
VA172773OtherBLUE CROSS
VA172773OtherBLUE CROSS
VA010134510Medicaid