Provider Demographics
NPI:1255325254
Name:PREWITT, KERRY C (MD)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:C
Last Name:PREWITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 SENTARA CIR
Mailing Address - Street 2:STE 320
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5716
Mailing Address - Country:US
Mailing Address - Phone:757-345-4800
Mailing Address - Fax:757-345-4801
Practice Address - Street 1:400 SENTARA CIR
Practice Address - Street 2:STE 320
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5716
Practice Address - Country:US
Practice Address - Phone:757-345-4800
Practice Address - Fax:757-345-4801
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057329207RC0000X, 207RI0011X
VA0101041337207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD759502600Medicaid
G00599Medicare UPIN
MD759502600Medicaid