Basic Information
| Provider Information | |||||||||
| NPI: | 1265467450 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBB | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7068 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237070068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576863539 | ||||||||
| FaxNumber: | 7576860230 | ||||||||
| Practice Location | |||||||||
| Address1: | 7924 CHESAPEAKE BLVD | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235183801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575871700 | ||||||||
| FaxNumber: | 7574801295 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 0101043647 | VA | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 541595397 | 01 | VA | TRICARE | OTHER | 005681405 | 05 | VA | MEDICAID | 413781 | 01 | VA | SOUTHERN HLTH | OTHER | 813135 | 01 | VA | MDIPA | OTHER | 541595397 | 01 | VA | VHN | OTHER | 095539 | 01 | VA | ANTHEM | OTHER | 4498322 | 01 | VA | AETNA | OTHER |