Mary Immaculate Hospital

Primary specialty

Gynecologic Oncology PhysicianTaxonomy code 207VX0201X

Legal business name

MARY IMMACULATE HOSPITAL

Practice address

500 Sentara Cir
Suite 102
Williamsburg, VA 23188-5727

Phone

(757) 984-9890

Fax

(757) 345-6659

NPI assigned

Sep 20, 2011

Organization subpart

Yes

Parent organization

MARY IMMACULATE HOSPITALAs reported in NPPES

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

Authorized official

Name

Michael K Kerner

Title

Ceo

Phone

(757) 673-5929

Specialties & licenses 1

Addresses

Other names 1

• Bon Secours Gynecologic Oncology Specialists Doing business as

Part of

Mary Immaculate Hospital

Locations

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

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328486400000",
    "number": "1265715932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 SENTARA CIR",
            "address_2": "SUITE 102",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231885727",
            "telephone_number": "757-984-9890",
            "fax_number": "757-345-6659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SENTARA CIR",
            "address_2": "SUITE 102",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231885727",
            "telephone_number": "757-984-9890",
            "fax_number": "757-345-6659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY IMMACULATE HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY IMMACULATE HOSPITAL",
        "enumeration_date": "2011-09-20",
        "last_updated": "2012-02-06",
        "status": "A",
        "authorized_official_last_name": "KERNER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "757-673-5929"
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bon Secours Gynecologic Oncology Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ladrena Nicole Martin, SUPERVISEE IN SW
• Tealece Martin
• Aniya Rosa Martinez
• Rey Martinez
• Charles Martino
• Wesley Nathaniel Mason, M.ED
• Massage Just 4 U LLC
• Alexis K Massengill, BT
• Christopher L Massengill, MD
• Massey Clinic LTD

• Gynecologic Oncology Physician in Williamsburg, VA
• Providers in Williamsburg, VA by specialty
• Gynecologic Oncology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 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.