Provider Demographics
NPI:1245055482
Name:REGENPRO WOUND SPECIALTY GROUP - HAMPTON ROADS, LLC
Entity type:Organization
Organization Name:REGENPRO WOUND SPECIALTY GROUP - HAMPTON ROADS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEZIAH MARIAE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-394-0652
Mailing Address - Street 1:3220 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3318
Mailing Address - Country:US
Mailing Address - Phone:434-264-1233
Mailing Address - Fax:434-264-1233
Practice Address - Street 1:2809 EMERYWOOD PKWY STE 330-E
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-3730
Practice Address - Country:US
Practice Address - Phone:434-264-1233
Practice Address - Fax:434-264-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty