Provider Demographics
NPI:1760460398
Name:PIKE, IRVING M (MD, FACG)
Entity Type:Individual
Prefix:DR
First Name:IRVING
Middle Name:M
Last Name:PIKE
Suffix:
Gender:M
Credentials:MD, FACG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5500
Mailing Address - Country:US
Mailing Address - Phone:757-464-1644
Mailing Address - Fax:757-363-1071
Practice Address - Street 1:1020 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5500
Practice Address - Country:US
Practice Address - Phone:757-464-1644
Practice Address - Fax:757-363-1071
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035444174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06258Medicare PIN
VAC05905Medicare PIN
VAB08710Medicare UPIN