Basic Information
Provider Information
NPI: 1558855064
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JUNGE
FirstName: JOSHUA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3715 SURRY RD
Address2:  
City: VIRGINIA BEACH
State: VA
PostalCode: 234551621
CountryCode: US
TelephoneNumber: 8054900001
FaxNumber:  
Practice Location
Address1: 620 JOHN PAUL JONES CIR
Address2:  
City: PORTSMOUTH
State: VA
PostalCode: 237082111
CountryCode: US
TelephoneNumber: 7579535000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/18/2018
LastUpdateDate: 06/27/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/27/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X125.071887ILY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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