Provider Demographics
NPI:1568579365
Name:BERMISA, ARTHUR V (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:V
Last Name:BERMISA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 AMERICAN LEGION RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5602
Mailing Address - Country:US
Mailing Address - Phone:757-673-6801
Mailing Address - Fax:757-673-6808
Practice Address - Street 1:110 AMERICAN LEGION RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5602
Practice Address - Country:US
Practice Address - Phone:757-673-6801
Practice Address - Fax:757-673-6808
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101225828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005614325Medicaid
080007638Medicare ID - Type Unspecified
VA005614325Medicaid