Provider Demographics
NPI:1316966328
Name:BEN-OTHMANE, KAMEL (MD)
Entity type:Individual
Prefix:
First Name:KAMEL
Middle Name:
Last Name:BEN-OTHMANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12200 WARWICK BLVD
Practice Address - Street 2:STE 110
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2548
Practice Address - Country:US
Practice Address - Phone:757-534-5100
Practice Address - Fax:757-534-5395
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012316512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1316966328Medicaid
VA1316966328Medicaid
VAP00478564Medicare PIN
H60690Medicare UPIN