Provider Demographics
NPI:1912035916
Name:OLD HAMPTON FAMILY MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:OLD HAMPTON FAMILY MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-728-1100
Mailing Address - Street 1:26 WINE ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-3584
Mailing Address - Country:US
Mailing Address - Phone:757-728-1100
Mailing Address - Fax:757-728-0870
Practice Address - Street 1:26 WINE ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-3584
Practice Address - Country:US
Practice Address - Phone:757-728-1100
Practice Address - Fax:757-728-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5637341Medicaid
VA005114OtherANTHEM
VA005114OtherANTHEM
VA080002422Medicare ID - Type Unspecified