Provider Demographics
NPI:1871501171
Name:OBROKTA, DEENA S (DO)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:S
Last Name:OBROKTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 DENBIGH BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4413
Mailing Address - Country:US
Mailing Address - Phone:757-883-0780
Mailing Address - Fax:757-883-0783
Practice Address - Street 1:606 DENBIGH BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4413
Practice Address - Country:US
Practice Address - Phone:757-883-0780
Practice Address - Fax:757-883-0783
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102050070208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010134951Medicaid
VA174020OtherANTHEM
5330435OtherAETNA
VA42040OtherSENTARA
9626040OtherCIGNA
9626040OtherCIGNA
VA010134951Medicaid