Provider Demographics
NPI:1205247079
Name:EBROM, PIERSON ANDERS (DO)
Entity type:Individual
Prefix:DR
First Name:PIERSON
Middle Name:ANDERS
Last Name:EBROM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 COLUMBUS ST
Mailing Address - Street 2:STE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6725
Mailing Address - Country:US
Mailing Address - Phone:757-772-6066
Mailing Address - Fax:
Practice Address - Street 1:4701 COLUMBUS ST STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6725
Practice Address - Country:US
Practice Address - Phone:757-772-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102206000207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine