Provider Demographics
NPI:1821017088
Name:KULBERG, HEIDI AMANDA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:AMANDA
Last Name:KULBERG
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4509 WHITECHAPEL DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6447
Mailing Address - Country:US
Mailing Address - Phone:757-460-4655
Mailing Address - Fax:757-460-7744
Practice Address - Street 1:4509 WHITECHAPEL DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6447
Practice Address - Country:US
Practice Address - Phone:757-460-4655
Practice Address - Fax:757-460-7744
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238091207QA0401X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No174400000XOther Service ProvidersSpecialist