Provider Demographics
NPI:1982244083
Name:CORNERSTONE PROFESSIONAL ORTHOPAEDICS SPORTS 4 CHRIST LLC
Entity Type:Organization
Organization Name:CORNERSTONE PROFESSIONAL ORTHOPAEDICS SPORTS 4 CHRIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CORNERSTONE PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-746-5342
Mailing Address - Street 1:PO BOX 4222
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-0222
Mailing Address - Country:US
Mailing Address - Phone:757-746-5342
Mailing Address - Fax:
Practice Address - Street 1:637 KINGSBOROUGH SQ STE D
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4944
Practice Address - Country:US
Practice Address - Phone:757-746-5342
Practice Address - Fax:833-954-0875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1457337107OtherNPI
VA1982244083OtherNPI 2 CORNERSTONE PROFESSIONAL ORTHOPAEDICS SPORTS 4 CHRIST
VAVV3082J829Medicaid