Provider Demographics
NPI:1467427286
Name:PORT WARWICK MEDICAL ARTS
Entity Type:Organization
Organization Name:PORT WARWICK MEDICAL ARTS
Other - Org Name:SENTARA HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELZARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:757-736-1215
Mailing Address - Street 1:3000 COLISEUM DR
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5963
Mailing Address - Country:US
Mailing Address - Phone:757-736-1221
Mailing Address - Fax:
Practice Address - Street 1:1031 LOFTIS BOULEVARD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606
Practice Address - Country:US
Practice Address - Phone:757-736-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0220000459261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center