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Individual

JEROME A PROVENZANO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
12655 WARWICK BLVD, NEWPORT NEWS, VA 23606-2501
(757) 595-9880
(757) 595-0362
Mailing address
860 OMNI BLVD STE 101, NEWPORT NEWS, VA 23606-4430
(757) 232-8769
(757) 232-8875

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101048791
VA

Other

Enumeration date
02/21/2006
Last updated
02/07/2020
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