Provider Demographics
NPI:1922042605
Name:INFECTIOUS DISEASE ASSOCIATES OF HAMPTON ROADS, LTD
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE ASSOCIATES OF HAMPTON ROADS, LTD
Other - Org Name:OYSTER POINT MEDICLA SPECIALISTS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-596-7115
Mailing Address - Street 1:11747 JEFFERSON AVENUE
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VI
Mailing Address - Zip Code:23606
Mailing Address - Country:US
Mailing Address - Phone:757-596-7115
Mailing Address - Fax:757-596-7127
Practice Address - Street 1:11747 JEFFERSON AVENUE
Practice Address - Street 2:SUITE 4C
Practice Address - City:NEWPORT NEWS
Practice Address - State:VI
Practice Address - Zip Code:23606
Practice Address - Country:US
Practice Address - Phone:757-596-7115
Practice Address - Fax:757-596-7127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherTAX ID NUMBER