Provider Demographics
NPI:1598924359
Name:KERN, NORA G (MD)
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:G
Last Name:KERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NORA
Other - Middle Name:G
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1204 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2824
Practice Address - Country:US
Practice Address - Phone:434-243-5500
Practice Address - Fax:434-924-8244
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101253657208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1598924359Medicaid
VAVVJ261AMedicare PIN