Provider Demographics
NPI:1316077894
Name:PRIMARY CARE PHYSICIANS OF HAMPTON ROADS PC
Entity type:Organization
Organization Name:PRIMARY CARE PHYSICIANS OF HAMPTON ROADS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:VERGARA
Authorized Official - Last Name:PARAGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-424-5778
Mailing Address - Street 1:1200 SOUTH MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320
Mailing Address - Country:US
Mailing Address - Phone:757-424-5778
Mailing Address - Fax:757-523-1699
Practice Address - Street 1:1200 SOUTH MILITARY HWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320
Practice Address - Country:US
Practice Address - Phone:757-424-5778
Practice Address - Fax:757-523-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08863Medicare PIN