Provider Demographics
NPI:1851391478
Name:AMBERMAN, GEORGE H III (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:H
Last Name:AMBERMAN
Suffix:III
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 1:1147 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5545
Mailing Address - Country:US
Mailing Address - Phone:757-460-1207
Mailing Address - Fax:757-460-2136
Practice Address - Street 1:1147 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5545
Practice Address - Country:US
Practice Address - Phone:757-460-1207
Practice Address - Fax:757-460-2136
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035205207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5608562Medicaid
VA0101035205OtherLIC
VA0101035205OtherLIC
VA5608562Medicaid