Provider Demographics
NPI:1780121962
Name:MARYVIEW HOSPITAL
Entity type:Organization
Organization Name:MARYVIEW HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-215-2784
Mailing Address - Street 1:7185 HARBOUR TOWNE PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3796
Mailing Address - Country:US
Mailing Address - Phone:757-934-2331
Mailing Address - Fax:757-686-1442
Practice Address - Street 1:7185 HARBOUR TOWNE PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3796
Practice Address - Country:US
Practice Address - Phone:757-934-2331
Practice Address - Fax:757-686-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05149Medicare PIN