Provider Demographics
NPI:1194899534
Name:FORT NORFOLK PLAZA MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:FORT NORFOLK PLAZA MEDICAL ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:NEWBY
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:757-627-6892
Mailing Address - Street 1:930 MAJESTIC AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-4055
Mailing Address - Country:US
Mailing Address - Phone:757-627-6892
Mailing Address - Fax:757-627-5809
Practice Address - Street 1:930 MAJESTIC AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-4055
Practice Address - Country:US
Practice Address - Phone:757-627-6892
Practice Address - Fax:757-627-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-18
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA103551OtherGROUP PTAN