Provider Demographics
NPI:1841466125
Name:COMPREHENSIVE MEDICAL CENTER I, INC
Entity type:Organization
Organization Name:COMPREHENSIVE MEDICAL CENTER I, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARI LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-481-5858
Mailing Address - Street 1:1340 N GREAT NECK RD
Mailing Address - Street 2:SUITE 1272 PMB 390
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2268
Mailing Address - Country:US
Mailing Address - Phone:757-481-5858
Mailing Address - Fax:
Practice Address - Street 1:5232 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4202
Practice Address - Country:US
Practice Address - Phone:757-495-5003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-06
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233341207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4507400002Medicare NSC
VAC10410Medicare PIN