Organization
BON SECOURS DEPAUL MEDICAL CENTER INC
Active
Other names
East Beach Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHAN QUIRICONI (CFO)
(804) 281-8301
Entity
Organization
Contact information
Practice address
4241 E LITTLE CREEK RD, NORFOLK, VA 23518-3546
(757) 738-1200
(757) 480-3208
Mailing address
8580 MAGELLAN PKWY, RICHMOND, VA 23227-1149
(804) 627-5462
(866) 449-0896
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C06209
GROUP PTAN
VA
Enumeration date
10/09/2013
Last updated
05/16/2019
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