Provider Demographics
NPI:1861686404
Name:ADULT AND PEDIATRIC NEUROSURGERY
Entity Type:Organization
Organization Name:ADULT AND PEDIATRIC NEUROSURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GURTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-622-1003
Mailing Address - Street 1:248 W BUTE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1440
Mailing Address - Country:US
Mailing Address - Phone:757-622-1003
Mailing Address - Fax:757-622-1108
Practice Address - Street 1:248 W BUTE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1440
Practice Address - Country:US
Practice Address - Phone:757-622-1003
Practice Address - Fax:757-622-1108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056357174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0004462765OtherAETNA
VA1400005733OtherRAILROAD MEDICARE
VA213281OtherCIGNA
NC790556QMedicaid
VA11481OtherOPTIMA
VA257818OtherANTHEM
VA6104916Medicaid
VA257818OtherANTHEM