Provider Demographics
NPI:1437699766
Name:AFFINITY HEALTHCARE GROUP NEWPORT NEWS, LLC
Entity Type:Organization
Organization Name:AFFINITY HEALTHCARE GROUP NEWPORT NEWS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-933-2660
Mailing Address - Street 1:6000 JEFFERSON AVE
Mailing Address - Street 2:#B
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605
Mailing Address - Country:US
Mailing Address - Phone:757-933-2660
Mailing Address - Fax:757-537-2365
Practice Address - Street 1:6000 JEFFERSON AVE
Practice Address - Street 2:#B
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-3266
Practice Address - Country:US
Practice Address - Phone:757-933-2660
Practice Address - Fax:757-537-2365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049004207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty