Provider Demographics
NPI:1992802722
Name:VITERBO-NOBLE, ELENA T (MD)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:T
Last Name:VITERBO-NOBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA ELENA
Other - Middle Name:T
Other - Last Name:VITERBO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606
Mailing Address - Country:US
Mailing Address - Phone:757-232-8777
Mailing Address - Fax:757-232-8866
Practice Address - Street 1:7151 RICHMOND ROAD
Practice Address - Street 2:SUITE405
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188
Practice Address - Country:US
Practice Address - Phone:757-564-3700
Practice Address - Fax:757-564-8515
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1992802722Medicaid
VA020603T77Medicare PIN