Provider Demographics
NPI:1285806786
Name:DENBIGH ORTHOPAEDICS & SPORTS MEDICINE, PC
Entity type:Organization
Organization Name:DENBIGH ORTHOPAEDICS & SPORTS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:STILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-872-0548
Mailing Address - Street 1:12720 MCMANUS BLVD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4414
Mailing Address - Country:US
Mailing Address - Phone:757-872-0548
Mailing Address - Fax:757-872-0551
Practice Address - Street 1:12720 MCMANUS BLVD
Practice Address - Street 2:SUITE 311
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4414
Practice Address - Country:US
Practice Address - Phone:757-872-0548
Practice Address - Fax:757-872-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101016325174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006400540Medicaid
VAB06588Medicare UPIN
VA006400540Medicaid