Provider Demographics
NPI:1831544964
Name:DIABETES EDUCATION ASSOCIATION OF VIRGINIA
Entity type:Organization
Organization Name:DIABETES EDUCATION ASSOCIATION OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:GREEN
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-243-5553
Mailing Address - Street 1:3826 WEDGEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4341
Mailing Address - Country:US
Mailing Address - Phone:803-243-5553
Mailing Address - Fax:803-243-5553
Practice Address - Street 1:3826 WEDGEFIELD AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4341
Practice Address - Country:US
Practice Address - Phone:803-243-5553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management