Active NPI 1225003361 Individual Practitioner Male Practitioner

Dr. Reginald B Henry , MD

Dermatology • Norfolk, VA

Professional Overview & Biography Verified Profile Summary

Dr. Reginald Henry, MD is a registered healthcare professional specializing in Dermatology in Norfolk, VA. Practice services are available at 850 KEMPSVILLE RD under active NPI credentials.

Frequently performed procedures and clinical services include established patient outpatient office visit, destruction of skin growth, destruction of precancer skin growth, 2-14 growths. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

850 Kempsville Rd
Ste 100d

Norfolk, VA 23502

Telephone 7572615944

Fax 7572610026

Associated Practice Facility / Clinic

🏢 Sentara Medical Group Facility NPI 1740228618

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology in Norfolk, VA

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 23.8 Yrs

State Avg: 23.2 Yrs

Regional Practice Density

19 Specialists

Practicing in Norfolk, VA (440 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

45.9% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2023)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	44	44	$64.27	$36.13
17000 Destruction of skin growth	19	19	$109.00	$54.60
17003 Destruction of precancer skin growth, 2-14 growths	17	12	$16.00	$2.03
99213 Established patient office or other outpatient visit, typically 15 minutes	12	12	$106.92	$67.44

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	399	166	$16.03	$2.12
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	378	345	$63.59	$36.80
17000 Destruction of skin growth	291	259	$109.16	$51.86
99213 Established patient office or other outpatient visit, typically 15 minutes	285	260	$103.33	$67.57
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	124	84	$159.48	$99.25
17110 Destruction of up to 14 skin growths	85	83	$163.71	$65.95
11102 Tangential biopsy of single skin lesion	81	79	$83.46	$29.48
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	38	30	$235.00	$94.67
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	24	21	$335.00	$118.89
11104 Punch biopsy, first skin growth	23	23	$102.00	$39.08
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	22	21	$384.86	$160.77
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	22	21	$453.00	$160.61
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	21	18	$292.00	$124.16
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	19	18	$404.37	$90.04
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	18	18	$359.00	$97.77
99202 New patient office or other outpatient visit, typically 20 minutes	13	13	$103.00	$49.24
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	13	13	$158.92	$81.54

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,376	471	$16.02	$2.13
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	1,369	1,003	$63.33	$36.40
17000 Destruction of skin growth	933	685	$109.10	$50.72
99213 Established patient office or other outpatient visit, typically 15 minutes	806	648	$103.58	$67.80
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	425	290	$160.84	$100.13
17110 Destruction of up to 14 skin growths	301	270	$163.60	$65.11
11102 Tangential biopsy of single skin lesion	253	237	$82.00	$29.38
99202 New patient office or other outpatient visit, typically 20 minutes	112	112	$105.28	$49.71
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	110	80	$235.00	$92.97
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	101	91	$453.00	$156.80
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	99	83	$336.70	$109.67
11104 Punch biopsy, first skin growth	72	68	$104.07	$42.43
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	65	56	$382.32	$143.61
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	54	53	$361.56	$100.10
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	52	50	$397.00	$109.61
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	48	42	$292.00	$131.86
11103 Biopsy of related skin growth, each additional growth	46	42	$47.00	$22.23
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	40	40	$260.00	$136.90
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	37	36	$351.00	$121.67
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	34	30	$252.00	$108.09
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	32	29	$259.00	$112.15
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	31	30	$401.00	$187.84
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	29	28	$423.62	$187.96
12042 Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm	28	27	$416.75	$176.93
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	26	26	$154.00	$84.06
12041 Intermediate repair of wound of neck, hands, feet, or genitals, 2.5 cm or less	25	25	$375.00	$87.88
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	22	20	$234.00	$58.32
11200 Removal of skin tag, 1-15 skin tags	18	18	$150.00	$73.62
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	17	16	$213.00	$74.69
11422 Removal of noncancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	15	13	$283.47	$85.15

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	2,168	1,437	$104.02	$52.67
17003 Destruction of precancer skin growth, 2-14 growths	1,019	369	$16.03	$2.21
17000 Destruction of skin growth	862	652	$109.37	$51.35
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	318	276	$63.79	$26.88
11102 Tangential biopsy of single skin lesion	248	228	$84.38	$32.15
17110 Destruction of up to 14 skin growths	241	214	$165.24	$67.89
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	143	124	$340.87	$138.01
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	126	118	$364.48	$102.30
11104 Punch biopsy, first skin growth	75	73	$103.99	$47.40
99202 New patient office or other outpatient visit, typically 20 minutes	67	67	$107.57	$52.27
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	66	64	$399.12	$119.36
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	60	55	$455.72	$165.13
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	60	54	$379.88	$162.38
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	58	45	$235.00	$95.47
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	44	43	$351.00	$151.31
12041 Intermediate repair of wound of neck, hands, feet, or genitals, 2.5 cm or less	38	37	$375.00	$86.12
11103 Biopsy of related skin growth, each additional growth	36	28	$47.00	$23.44
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	30	27	$252.00	$110.77
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	30	24	$213.00	$67.46
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	26	21	$292.00	$123.99
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	22	19	$161.73	$81.92
11641 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	20	20	$321.00	$87.98
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	20	18	$265.05	$114.61
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	20	20	$234.00	$59.01
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	18	18	$410.61	$187.97
17271 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	18	17	$224.00	$102.80
11900 Injection into skin growth, 1-7 growths	16	11	$83.00	$28.41
12042 Intermediate repair of wound of neck, hands, feet, or genitals, 2.6-7.5 cm	15	15	$410.00	$170.29
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	13	13	$417.00	$191.72
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	11	11	$276.00	$139.52

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	2,001	1,409	$145.00	$51.40
17003 Destruction of precancer skin growth, 2-14 growths	1,115	413	$24.06	$2.48
17000 Destruction of skin growth	871	669	$153.00	$51.27
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	487	422	$87.00	$25.68
17110 Destruction of up to 14 skin growths	290	273	$221.00	$68.95
11102 Tangential biopsy of single skin lesion	221	201	$199.00	$32.38
99213 Established patient office or other outpatient visit, typically 15 minutes	169	164	$145.00	$51.45
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	133	123	$472.00	$95.78
99202 New patient office or other outpatient visit, typically 20 minutes	122	122	$149.00	$51.01
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	115	98	$493.00	$153.20
11104 Punch biopsy, first skin growth	106	102	$250.00	$45.10
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	83	77	$516.00	$124.26
17003 Destruction of precancer skin growth, 2-14 growths	66	31	$24.00	$2.44
17000 Destruction of skin growth	58	58	$153.00	$50.89
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	51	47	$542.00	$179.04
12041 Intermediate repair of wound of neck, hands, feet, or genitals, 2.5 cm or less	39	38	$472.00	$84.06
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	39	39	$87.00	$27.53
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	37	31	$354.00	$107.10
11641 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	35	32	$474.00	$93.64
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	34	33	$511.00	$175.14
11103 Biopsy of related skin growth, each additional growth	31	26	$107.00	$23.47
17110 Destruction of up to 14 skin growths	27	27	$221.00	$60.82
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	26	26	$605.00	$144.87
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	24	23	$349.00	$105.08
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	23	21	$286.00	$73.76
11900 Injection into skin growth, 1-7 growths	22	12	$110.00	$31.29
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	18	16	$408.00	$133.57
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	17	17	$330.00	$65.31
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	16	15	$565.00	$193.77
11102 Tangential biopsy of single skin lesion	16	15	$199.00	$36.63
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	15	13	$213.00	$79.26
11200 Removal of skin tag, 1-15 skin tags	13	13	$175.00	$74.66
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	12	12	$273.00	$137.71
11601 Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs	11	11	$454.00	$76.22

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	1,906	1,261	$145.00	$51.02
17000 Destruction of skin growth	886	655	$153.00	$49.77
17003 Destruction of precancer skin growth, 2-14 growths	866	347	$24.00	$2.44
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	645	543	$87.00	$25.32
11100 Biopsy of single growth of skin and/or tissue	325	282	$206.00	$40.72
17110 Destruction of up to 14 skin growths	308	282	$221.00	$68.13
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	137	130	$472.00	$93.48
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	124	105	$493.00	$150.20
99202 New patient office or other outpatient visit, typically 20 minutes	112	112	$149.00	$50.04
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	63	59	$516.00	$108.33
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	61	49	$349.00	$102.58
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	55	51	$542.00	$178.30
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	49	44	$354.00	$114.10
11101 Biopsy of each additional growth of skin and/or tissue	43	37	$65.00	$25.18
12041 Intermediate repair of wound of neck, hands, feet, or genitals, 2.5 cm or less	34	33	$472.00	$89.09
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	33	31	$286.00	$78.16
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	31	29	$511.00	$166.86
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	26	22	$356.73	$118.59
11641 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	25	22	$474.00	$87.93
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	24	23	$605.00	$147.13
17271 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	22	19	$325.00	$98.74
99201 New patient office or other outpatient visit, typically 10 minutes	19	19	$87.00	$26.72
99213 Established patient office or other outpatient visit, typically 15 minutes	18	15	$145.00	$52.91
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	17	17	$330.00	$57.51
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	12	11	$565.00	$197.53
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	11	11	$408.00	$137.87

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	1,742	1,175	$145.00	$50.42
17003 Destruction of precancer skin growth, 2-14 growths	1,109	396	$24.00	$2.41
17000 Destruction of skin growth	945	715	$153.00	$50.16
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	676	562	$87.00	$25.18
17110 Destruction of up to 14 skin growths	306	278	$221.00	$68.68
11100 Biopsy of single growth of skin and/or tissue	296	268	$206.00	$41.27
99202 New patient office or other outpatient visit, typically 20 minutes	191	191	$149.00	$50.04
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	122	100	$493.00	$144.24
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	117	105	$472.00	$90.98
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	60	52	$354.00	$113.67
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	58	56	$516.00	$110.97
99201 New patient office or other outpatient visit, typically 10 minutes	56	56	$87.00	$26.53
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	45	45	$542.00	$178.47
11101 Biopsy of each additional growth of skin and/or tissue	41	37	$65.00	$25.02
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	39	37	$349.00	$105.98
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	32	29	$408.00	$132.73
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	31	31	$605.00	$148.24
12041 Intermediate repair of wound of neck, hands, feet, or genitals, 2.5 cm or less	27	26	$472.00	$89.35
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	26	24	$511.00	$165.31
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	22	20	$371.00	$113.24
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	21	20	$286.00	$78.36
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	20	20	$215.00	$75.76
99213 Established patient office or other outpatient visit, typically 15 minutes	19	14	$145.00	$37.62
11641 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	19	19	$474.00	$94.70
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	18	16	$330.00	$56.78
17271 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	16	13	$325.00	$90.07
11900 Injection into skin growth, 1-7 growths	15	12	$110.00	$28.23
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	13	12	$565.00	$181.18

Medical Specialties & State Licenses

CMS Verified: 2021-11-17

Dermatology Primary Specialty

NUCC Taxonomy Code: 207N00000X

State License VA 0101036226

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

005900212 (VA)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners

Dr. John Carrick , MD

Internal Medicine

NPI 1013982230

Doctor of Medicine (M.D.)

Dr. Anthony Larocco , MD

Internal Medicine - Infectious Disease

NPI 1023083094

Doctor of Medicine (M.D.)

Dr. William Gough , MD

Internal Medicine - Rheumatology

NPI 1023083151

Doctor of Medicine (M.D.)

Dr. Marc Pessar , MD

Radiology - Diagnostic Radiology

NPI 1043285182

Doctor of Medicine (M.D.)

Dr. Mark Jenison , MD

Dermatology

NPI 1134194277

Doctor of Medicine (M.D.)

Jodi Henke , PA-C

Physician Assistant

NPI 1134356215

Physician Assistant (Certified)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active January 15, 2014

NPI status registered as active in NPPES database

📍

Updated Practice Location January 15, 2014

Registered at 850 KEMPSVILLE RD, STE 100D, NORFOLK, VA 23502 (Tel: 7572615944)

📍

Updated Business Mailing Address January 15, 2014

Registered at 850 KEMPSVILLE RD, STE 100D, NORFOLK, VA 23502 (Tel: 7572615944)

👤

Provider Name / Credentials Updated January 15, 2014

Recorded as REGINALD HENRY, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) January 15, 2014

Dermatology (License #0101036226 in VA)

🟢

Initial NPI Registration & Enumeration February 22, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1225003361

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: February 22, 2006

Last Update: November 17, 2021

Sole Proprietor: No

Update or Correct Profile

Mailing Address

850 Kempsville Rd, Ste 100d

Norfolk, VA 23502

Phone: 7572615944

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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