Provider Demographics
NPI:1740470376
Name:NORTHAM, DRINA ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:DRINA
Middle Name:ANNE
Last Name:NORTHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11747 JEFFERSON AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4401
Mailing Address - Country:US
Mailing Address - Phone:757-592-9600
Mailing Address - Fax:
Practice Address - Street 1:11747 JEFFERSON AVE STE 1B
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4401
Practice Address - Country:US
Practice Address - Phone:757-592-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101250091174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101250091OtherVIRGINIA LICENSE