Organization
CHESAPEAKE BAY ENT
Active
Other names
Coastal Plain ENT
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DETRA RENEE SAFFOLD (REGIONAL PRACTICE ADMINISTRATOR)
(757) 821-2090
Entity
Organization
Contact information
Practice address
1232 PERIMETER PKWY, SUITE 104, VIRGINIA BEACH, VA 23454-5924
(757) 821-2090
(757) 821-2091
Mailing address
PO BOX 68279, VIRGINIA BEACH, VA 23471-8279
(757) 821-2090
(757) 821-2091
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001371
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1689693939
NPI
—
Enumeration date
02/23/2015
Last updated
02/23/2015
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