NPIMap

Organization Active NPI

Peninsula Vascular Center, P.C.

  • Nephrology Physician
  • Hampton, VA
National Provider Identifier
1093070781
Registry record updated Jul 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
PENINSULA VASCULAR CENTER, P.C.
Practice address
501 Butler Farm Rd
Suite B
Hampton, VA 23666-1777
Phone
(757) 766-6080
Fax
(757) 766-6085
NPI assigned
Jul 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Khalil B Dahdah, MD
Title
Managing Partner
Phone
(757) 766-6080

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X Primary
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X

Addresses

Primary practice location

501 Butler Farm Rd
Suite B
Hampton, VA 23666-1777

Mailing address

501 Butler Farm Rd
Suite I
Hampton, VA 23666-1777
Phone (757) 766-6080

National Provider Directory

National Provider Directory

Locations

501 Butler Farm Rd
Ste I
Hampton, VA 23666
Phone (757) 251-7469

501 Butler Farm Rd
Ste B
Hampton, VA 23666
Phone (757) 766-6080

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341792000000",
    "number": "1093070781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 BUTLER FARM RD",
            "address_2": "SUITE I",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236661777",
            "telephone_number": "757-766-6080",
            "fax_number": "757-766-6085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 BUTLER FARM RD",
            "address_2": "SUITE B",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236661777",
            "telephone_number": "757-766-6080",
            "fax_number": "757-766-6085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA VASCULAR CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-09",
        "last_updated": "2012-07-09",
        "status": "A",
        "authorized_official_last_name": "DAHDAH",
        "authorized_official_first_name": "KHALIL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "757-766-6080",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hampton, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.