Provider Demographics
NPI:1265467450
Name:WEBB, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:WEBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3539
Mailing Address - Fax:757-686-0230
Practice Address - Street 1:7924 CHESAPEAKE BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-3801
Practice Address - Country:US
Practice Address - Phone:757-587-1700
Practice Address - Fax:757-480-1295
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043647208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541595397OtherTRICARE
VA005681405Medicaid
VA413781OtherSOUTHERN HLTH
VA813135OtherMDIPA
VA541595397OtherVHN
VA095539OtherANTHEM
VA4498322OtherAETNA
VAPO00204669Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VA095539OtherANTHEM
VA010000685Medicare ID - Type Unspecified