Individual
NIR HOREV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
150 KINGSLEY LN, NORFOLK, VA 23505-4602
(757) 967-8622
(757) 686-0541
Mailing address
PO BOX 7068, PORTSMOUTH, VA 23707-0068
(757) 967-8622
(757) 686-0541
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101255898
VA
Other
Enumeration date
04/01/2014
Last updated
07/22/2014
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