Provider Demographics
NPI:1326069865
Name:MOTLEY, VICKIE CORTESSA (MD)
Entity Type:Individual
Prefix:DR
First Name:VICKIE
Middle Name:CORTESSA
Last Name:MOTLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 EXECUTIVE DR
Mailing Address - Street 2:STE. D
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2582
Mailing Address - Country:US
Mailing Address - Phone:757-826-6889
Mailing Address - Fax:
Practice Address - Street 1:2200 EXECUTIVE DR
Practice Address - Street 2:STE. D
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2582
Practice Address - Country:US
Practice Address - Phone:757-826-6889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038366208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
B-07497Medicare UPIN