Provider Demographics
NPI:1700939980
Name:HAMPTON ROADS OTOLARYNGOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:HAMPTON ROADS OTOLARYNGOLOGY ASSOCIATES PLLC
Other - Org Name:HAMPTON ROADS EN-ALLERGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARCUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-825-2500
Mailing Address - Street 1:901 ENTERPRISE PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6249
Mailing Address - Country:US
Mailing Address - Phone:757-825-2500
Mailing Address - Fax:757-825-2521
Practice Address - Street 1:901 ENTERPRISE PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6249
Practice Address - Country:US
Practice Address - Phone:757-825-2500
Practice Address - Fax:757-825-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06204Medicare UPIN
VADA1280Medicare PIN