Provider Demographics
NPI:1790744498
Name:DE VERTEUIL, VIRGINIA K (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:K
Last Name:DE VERTEUIL
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 1:1085 BEECHER XING N
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4563
Mailing Address - Country:US
Mailing Address - Phone:614-741-8300
Mailing Address - Fax:614-741-8271
Practice Address - Street 1:1085 BEECHER XING N
Practice Address - Street 2:SUITE A
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-4563
Practice Address - Country:US
Practice Address - Phone:614-741-8300
Practice Address - Fax:614-741-8271
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.048560208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0618782Medicaid