Provider Demographics
NPI:1275585770
Name:ASHBY, KERMIT BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:KERMIT
Middle Name:BERNARD
Last Name:ASHBY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 WATER FOWL DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-2943
Mailing Address - Country:US
Mailing Address - Phone:757-206-5748
Mailing Address - Fax:757-890-0680
Practice Address - Street 1:100 EMANCIPATION DR
Practice Address - Street 2:VA MEDICAL CENTER / IMAGING DEPARTMENT
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23667-0001
Practice Address - Country:US
Practice Address - Phone:757-722-9961
Practice Address - Fax:757-728-3471
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01010363692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE27217Medicare UPIN