Provider Demographics
NPI:1922043702
Name:SUMMIT MEDICAL DIAGNOSTICS INC
Entity Type:Organization
Organization Name:SUMMIT MEDICAL DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-873-9580
Mailing Address - Street 1:PO BOX 1247
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23327-1247
Mailing Address - Country:US
Mailing Address - Phone:757-410-8954
Mailing Address - Fax:757-410-8963
Practice Address - Street 1:11842 ROCK LANDING DR
Practice Address - Street 2:SUITE 110
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4437
Practice Address - Country:US
Practice Address - Phone:757-873-9580
Practice Address - Fax:757-873-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAFVS007Medicare ID - Type UnspecifiedPROVIDER NUMBER