Provider Demographics
NPI:1457027344
Name:HAMPTON ROADS KIDNEY & INTERNAL MEDICINE LLC
Entity Type:Organization
Organization Name:HAMPTON ROADS KIDNEY & INTERNAL MEDICINE LLC
Other - Org Name:HAMPTON ROADS KIDNEY AND INTERNAL MEDICINE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-729-0924
Mailing Address - Street 1:5234 DEFORD RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-7208
Mailing Address - Country:US
Mailing Address - Phone:757-499-6978
Mailing Address - Fax:858-925-1353
Practice Address - Street 1:3800 POPLAR HILL RD STE A
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5522
Practice Address - Country:US
Practice Address - Phone:757-499-6978
Practice Address - Fax:858-925-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty