Individual
JEFFREY ALLEN VANDESAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
860 OMNI BLVD STE 109, NEWPORT NEWS, VA 23606-4430
(757) 232-8769
(757) 232-8875
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
2085R0202X
Diagnostic Radiology Physician
Primary
0101243665
VA
390200000X
Student in an Organized Health Care Education/Training Program
0116016608
VA
Other
Enumeration date
05/22/2007
Last updated
12/02/2019
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