Provider Demographics
NPI:1073516928
Name:VRETAKIS, GEORGE N (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:N
Last Name:VRETAKIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 S ROSEMONT RD
Mailing Address - Street 2:STE 215
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4336
Mailing Address - Country:US
Mailing Address - Phone:757-431-9551
Mailing Address - Fax:757-431-9663
Practice Address - Street 1:138 S ROSEMONT RD
Practice Address - Street 2:STE 215
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4336
Practice Address - Country:US
Practice Address - Phone:757-431-9551
Practice Address - Fax:757-431-9663
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047907207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA092861OtherANTHEM BC/BS OF VA
NC0500NOtherBLUECROSS/BLUESHIELD NC
VA15565OtherOPTIMA/SENTARA
NC890500NMedicaid
VACJ0275OtherMEDICARE RAIL ROAD
NC890500NMedicaid