Organization
ADULT AND PEDIATRIC NEUROSURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETRA GURTNER MD (PRESIDENT)
(757) 622-1003
Entity
Organization
Contact information
Practice address
248 W BUTE ST, SUITE 100, NORFOLK, VA 23510-1440
(757) 622-1003
(757) 622-1108
Mailing address
248 W BUTE ST, SUITE 100, NORFOLK, VA 23510-1440
(757) 622-1003
(757) 622-1108
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101056357
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004462765
AETNA
VA
01
—
11481
OPTIMA
VA
01
—
1400005733
RAILROAD MEDICARE
VA
01
—
213281
CIGNA
VA
01
—
257818
ANTHEM
VA
05
—
6104916
—
VA
05
—
790556Q
—
NC
Enumeration date
08/28/2007
Last updated
10/03/2011
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