Provider Demographics
NPI:1396056982
Name:FORT NORFOLK PLAZA MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:FORT NORFOLK PLAZA MEDICAL ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:H
Authorized Official - Last Name:NEWBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-624-1785
Mailing Address - Street 1:301 RIVERVIEW AVENUE
Mailing Address - Street 2:SUTIE 500
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1064
Mailing Address - Country:US
Mailing Address - Phone:757-624-1785
Mailing Address - Fax:757-624-1759
Practice Address - Street 1:301 RIVERVIEW AVE STE 500
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1066
Practice Address - Country:US
Practice Address - Phone:757-624-1785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA103548OtherGROUP PTAN