Organization
GENESIS AESTHETIC FACE AND VEIN SPECIALISTS, PC
Active
Organization
GENESIS AESTHETIC FACE AND VEIN SPECIALISTS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH CAMERON NICHOLS MD (PRESIDENT)
(757) 686-9747
Entity
Organization
Contact information
Practice address
1500 BREEZEPORT WAY, SUITE 100, SUFFOLK, VA 23435-3727
(757) 686-9747
Mailing address
1500 BREEZEPORT WAY, SUITE 100, SUFFOLK, VA 23435-3727
(757) 686-9747
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
0101040623
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00208779
RAILROAD MEDICARE
VA
Enumeration date
09/27/2007
Last updated
07/16/2008
Update your record
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