Provider Demographics
NPI:1871684563
Name:HAMPTON ROADS GASTROENTEROLOGY, P.C.
Entity Type:Organization
Organization Name:HAMPTON ROADS GASTROENTEROLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MICHAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-826-7785
Mailing Address - Street 1:501 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6080
Mailing Address - Country:US
Mailing Address - Phone:757-826-3434
Mailing Address - Fax:757-826-9028
Practice Address - Street 1:501 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6080
Practice Address - Country:US
Practice Address - Phone:757-826-3434
Practice Address - Fax:757-826-9028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0000000274551OtherANTHEM
VA0000000274551OtherANTHEM