Provider Demographics
NPI:1649356940
Name:OPPENHEIM, ARNOLD R (MD)
Entity type:Individual
Prefix:
First Name:ARNOLD
Middle Name:R
Last Name:OPPENHEIM
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 1:3729 REDWOOD FARM DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4640
Mailing Address - Country:US
Mailing Address - Phone:757-498-1356
Mailing Address - Fax:
Practice Address - Street 1:5320 PROVIDENCE RD STE 202
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4122
Practice Address - Country:US
Practice Address - Phone:757-523-4800
Practice Address - Fax:757-523-5857
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0087639207N00000X
VA0101033623174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB09493Medicare UPIN