Basic Information
| Provider Information | |||||||||
| NPI: | 1639114713 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAMPTON ROADS NEONATOLOGY PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 634579 | ||||||||
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| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452634579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004436372 | ||||||||
| FaxNumber: | 8655607310 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 J CLYDE MORRIS BLVD | ||||||||
| Address2: | |||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236011929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578686775 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 06/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | ABDALLAAH | ||||||||
| AuthorizedOfficialFirstName: | ADEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7578686775 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 264478 | 01 | VA | BLUE SHIELD | OTHER |