Provider Demographics
NPI:1851458244
Name:INTERNAL MEDICINE SPECIALIST INC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE SPECIALIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:HEIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-622-3252
Mailing Address - Street 1:142 W YORK ST
Mailing Address - Street 2:508
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2015
Mailing Address - Country:US
Mailing Address - Phone:757-622-3252
Mailing Address - Fax:757-627-1726
Practice Address - Street 1:142 W YORK ST
Practice Address - Street 2:508
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2015
Practice Address - Country:US
Practice Address - Phone:757-622-3252
Practice Address - Fax:757-627-1726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6052649Medicaid
VA5824826Medicaid
VA6059953Medicaid
VA6006191Medicaid
VA5824826Medicaid
VAB06085Medicare UPIN
VA6059953Medicaid
VA6052649Medicaid