Basic Information
| Provider Information | |||||||||
| NPI: | 1922043702 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMIT MEDICAL DIAGNOSTICS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1247 | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233271247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574108954 | ||||||||
| FaxNumber: | 7574108963 | ||||||||
| Practice Location | |||||||||
| Address1: | 11842 ROCK LANDING DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236064437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578739580 | ||||||||
| FaxNumber: | 7578739050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 07/16/2009 | ||||||||
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| AuthorizedOfficialLastName: | CHARNEY | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 7578739580 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.