Provider Demographics
NPI:1497823728
Name:INTERNAL MEDICINE KIDNEY & HYPERTENSION CENTER PC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE KIDNEY & HYPERTENSION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:F
Authorized Official - Last Name:PAVON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-502-4840
Mailing Address - Street 1:5700 LAKE WRIGHT DR STE 101
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-1859
Mailing Address - Country:US
Mailing Address - Phone:757-502-4840
Mailing Address - Fax:757-502-4841
Practice Address - Street 1:5700 LAKE WRIGHT DR STE 101
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-1859
Practice Address - Country:US
Practice Address - Phone:757-502-4840
Practice Address - Fax:757-502-4841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101024987207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10010Medicare PIN
VADF6510Medicare PIN