Provider Demographics
NPI:1639213192
Name:HEUSER, GEORGE KELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:KELLY
Last Name:HEUSER
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 1:1744 JACK FROST RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-3221
Mailing Address - Country:US
Mailing Address - Phone:757-464-2330
Mailing Address - Fax:757-552-7108
Practice Address - Street 1:1744 JACK FROST RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-3221
Practice Address - Country:US
Practice Address - Phone:757-464-2330
Practice Address - Fax:757-552-7108
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine