Organization
BREAST CARE SPECIALISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DESIREE MARIE SQUIRES (OFFICE MANAGER)
(757) 622-8032
Entity
Organization
Contact information
Practice address
5900 LAKE WRIGHT DR, SUITE 201, NORFOLK, VA 23502-1871
(757) 622-8032
(757) 625-7016
Mailing address
5900 LAKE WRIGHT DR, SUITE 201, NORFOLK, VA 23502-1871
(757) 622-8032
(757) 625-7016
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0695A
ANTHEM BC BS OF NC
NC
01
—
250256
ANTHEM BC BS
VA
01
—
RR020018463
MEDICARE RAILROAD
VA
Enumeration date
04/24/2007
Last updated
02/01/2013
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