Provider Demographics
NPI:1023050465
Name:SOUTHERN SURGICAL ASSOCIATES, PLLC T/A NORFOLK SURGICAL GROUP
Entity type:Organization
Organization Name:SOUTHERN SURGICAL ASSOCIATES, PLLC T/A NORFOLK SURGICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOHLGEMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-461-2515
Mailing Address - Street 1:6160 KEMPSVILLE CIR
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3933
Mailing Address - Country:US
Mailing Address - Phone:757-461-2515
Mailing Address - Fax:757-466-1104
Practice Address - Street 1:6160 KEMPSVILLE CIR
Practice Address - Street 2:SUITE 101B
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3933
Practice Address - Country:US
Practice Address - Phone:757-461-2515
Practice Address - Fax:757-466-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05426Medicare PIN