Provider Demographics
NPI:1346551736
Name:GHENT INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:GHENT INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLUMENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-622-6601
Mailing Address - Street 1:400 GRESHAM DR
Mailing Address - Street 2:STE. 205
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1903
Mailing Address - Country:US
Mailing Address - Phone:757-622-6601
Mailing Address - Fax:757-622-8029
Practice Address - Street 1:400 GRESHAM DR
Practice Address - Street 2:STE. 205
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1901
Practice Address - Country:US
Practice Address - Phone:757-622-6601
Practice Address - Fax:757-622-8029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041956207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1790770030Medicaid
VA224644020OtherTRICARE
VA1790770030OtherANTHEM
VA1790770030OtherANTHEM
VA224644020OtherTRICARE