Provider Demographics
NPI:1316274145
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:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-624-1785
Mailing Address - Street 1:301 RIVERVIEW AVENUE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1064
Mailing Address - Country:US
Mailing Address - Phone:757-227-6866
Mailing Address - Fax:757-743-1974
Practice Address - Street 1:301 RIVERVIEW AVENUE
Practice Address - Street 2:SUITE 525
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1064
Practice Address - Country:US
Practice Address - Phone:757-227-6866
Practice Address - Fax:757-277-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA103549OtherGROUP PTAN