Provider Demographics
NPI:1922342476
Name:HAMPTON ROADS ULTRASOUND
Entity Type:Organization
Organization Name:HAMPTON ROADS ULTRASOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALPHONZO
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALLS
Authorized Official - Suffix:
Authorized Official - Credentials:RVT
Authorized Official - Phone:757-749-2308
Mailing Address - Street 1:2736 GUM RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-1516
Mailing Address - Country:US
Mailing Address - Phone:757-749-2308
Mailing Address - Fax:
Practice Address - Street 1:2736 GUM RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-1516
Practice Address - Country:US
Practice Address - Phone:757-749-2308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-22
Last Update Date:2012-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Single Specialty