Organization
EASTERN VIRGINIA MEDICAL SCHOOL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK R. BABASHANIAN (VP-ADMINISTRATION/FINANCE)
(757) 446-6001
Entity
Organization
Contact information
Practice address
721 FAIRFAX AVE, NORFOLK, VA 23507-2007
(757) 451-6200
(757) 451-6251
Mailing address
PO BOX 936, NORFOLK, VA 23501-0936
(757) 451-6200
(757) 451-6251
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801185435
—
VA
Enumeration date
04/05/2011
Last updated
08/23/2011
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