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Organization

PRIMEDOC OF NORFOLK PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ROBERT J REYNOLDS MD (PRESIDENT)
(828) 210-3260
Entity
Organization

Contact information

Practice address
150 KINGSLEY LN, NORFOLK, VA 23505-4602
(843) 237-3378
(843) 237-5073
Mailing address
PO BOX 601835, CHARLOTTE, NC 28260-1835
(843) 237-3378
(843) 237-5073

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1588693725
VA
01
246875
BLUE SHIELD
VA
01
DF0829
RAILROAD MEDICARE
VA
Enumeration date
07/01/2006
Last updated
03/17/2009
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