Individual
DR. KEVIN HALISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
110 KINGSLEY LN, SUITE 305, NORFOLK, VA 23505-4614
(804) 262-6900
Mailing address
110 KINGSLEY LN STE 305, NORFOLK, VA 23505-4617
(757) 889-5422
(757) 889-5450
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101049901
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10145953
—
VA
Enumeration date
03/20/2006
Last updated
06/18/2019
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