Provider Demographics
NPI:1558606319
Name:PRINCESS ANNE ENT & ALLERGY, PC.
Entity Type:Organization
Organization Name:PRINCESS ANNE ENT & ALLERGY, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:W
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:757-507-0340
Mailing Address - Street 1:828 HEALTHY WAY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7958
Mailing Address - Country:US
Mailing Address - Phone:757-507-0340
Mailing Address - Fax:757-507-0341
Practice Address - Street 1:828 HEALTHY WAY
Practice Address - Street 2:SUITE 280
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7958
Practice Address - Country:US
Practice Address - Phone:757-507-0340
Practice Address - Fax:757-507-0341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054182174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty