Active NPI
Bon Secours Depaul Medical Center
Doing business as DePaul/EVMS Otolaryngology Head and Neck Surgery
- Otolaryngology Physician
- Norfolk, VA
National Provider Identifier
1548520315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- Legal business name
- BON SECOURS DEPAUL MEDICAL CENTER
- Doing business as
- DePaul/EVMS Otolaryngology Head and Neck Surgery
- Practice address
- 100 Kingsley LN
Suite 404
Norfolk, VA 23505-4604 - Phone
- (757) 889-5632
- Fax
- (757) 889-5633
- NPI assigned
- May 25, 2012
- Organization subpart
- Yes
- Parent organization
- BON SECOURS DEPAUL MEDICAL CENTER
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | Primary |
Addresses
Primary practice location
100 Kingsley LN
Suite 404
Norfolk, VA 23505-4604
Mailing address
100 Kingsley LN
Suite 404
Norfolk, VA 23505-4604
Phone (757) 889-5632
Other names 1
- DePaul/EVMS Otolaryngology Head and Neck Surgery
National Provider Directory
National Provider Directory- Part of
- Bon Secours Depaul Med Ctr
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337904000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1340668800000",
"number": "1548520315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 KINGSLEY LN",
"address_2": "SUITE 404",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235054604",
"telephone_number": "757-889-5632",
"fax_number": "757-889-5633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 KINGSLEY LN",
"address_2": "SUITE 404",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235054604",
"telephone_number": "757-889-5632",
"fax_number": "757-889-5633"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BON SECOURS DEPAUL MEDICAL CENTER",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "BON SECOURS DEPAUL MEDICAL CENTER",
"enumeration_date": "2012-05-25",
"last_updated": "2012-06-26",
"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": "207Y00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Otolaryngology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "DePaul/EVMS Otolaryngology Head and Neck Surgery",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Norfolk, VA
- Jamar L Bolden
- Matthew Steven Bolduc, DDS
- Elizabeth Bolt
- Bon Secours Depaul Medical Center (Bon Secours Medical Associates II)
- Bon Secours Depaul Medical Center (The Wound Care & Hyperbaric Oxygen Center)
- Bon Secours Depaul Medical Center (Bon Secours Contemporary Medicine)
- Bon Secours Depaul Medical Center (Internal Medicine Specialists)
- Bon Secours Depaul Medical Center Crna
- Bon Secours Depaul Medical Center Image Recovery Center
- Bon Secours Depaul Medical Center Inc (Transitional Care Center at DePaul Medical Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.