Provider Demographics
NPI:1598743692
Name:MCCAMMON, KURT A (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:A
Last Name:MCCAMMON
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 1:225 CLEARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1815
Mailing Address - Country:US
Mailing Address - Phone:757-457-5110
Mailing Address - Fax:757-466-3411
Practice Address - Street 1:225 CLEARFIELD AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1815
Practice Address - Country:US
Practice Address - Phone:757-457-5110
Practice Address - Fax:757-466-3411
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057382208800000X, 2088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007502419Medicaid
VA1598743692OtherANTHEM
VA13766OtherSENTARA HEALTHCARE
VA394266OtherANTHEM BC BS
VA007502419Medicaid
VA13766OtherSENTARA HEALTHCARE
VA1598743692OtherANTHEM