Provider Demographics
NPI:1528207339
Name:HAMPTON ROADS INSTITUTE FOR PERFORMANCE & SPORTS MEDICINE PLC
Entity Type:Organization
Organization Name:HAMPTON ROADS INSTITUTE FOR PERFORMANCE & SPORTS MEDICINE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-393-0099
Mailing Address - Street 1:500 RODMAN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3100
Mailing Address - Country:US
Mailing Address - Phone:757-393-0099
Mailing Address - Fax:757-393-2720
Practice Address - Street 1:500 RODMAN AVE STE 1
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3100
Practice Address - Country:US
Practice Address - Phone:757-393-0099
Practice Address - Fax:757-393-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010153048261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-017OtherTRICARE