Bon Secours Depaul Medical Center

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

BON SECOURS DEPAUL MEDICAL CENTER

Practice address

400 Gresham Dr
Suite 808
Norfolk, VA 23507-1901

Phone

(757) 622-7998

Fax

(757) 215-2729

NPI assigned

Oct 16, 2013

Organization subpart

No

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

Authorized official

Name

Michael Kerner

Title

Cheif Executive Officer

Phone

(757) 673-5920

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bon Secours Contemporary Medicine Doing business as

Locations

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

{
    "created_epoch": "1381881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381881600000",
    "number": "1740618412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 GRESHAM DR",
            "address_2": "SUITE 808",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071901",
            "telephone_number": "757-622-7998",
            "fax_number": "757-215-2729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 GRESHAM DR",
            "address_2": "SUITE 808",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071901",
            "telephone_number": "757-622-7998",
            "fax_number": "757-215-2729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS DEPAUL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-16",
        "last_updated": "2013-10-16",
        "status": "A",
        "authorized_official_last_name": "KERNER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHEIF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "757-673-5920"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "C06209",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bon Secours Contemporary Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Matthew Steven Bolduc, DDS
• Elizabeth Bolt
• Bon Secours Depaul Medical Center
• Bon Secours Depaul Medical Center
• Bon Secours Depaul Medical Center
• Bon Secours Depaul Medical Center
• Bon Secours Depaul Medical Center Crna
• Bon Secours Depaul Medical Center Image Recovery Center
• Bon Secours Depaul Medical Center Inc
• Bon Secours Depaul Medical Center Inc

• Internal Medicine Physician in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Internal Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2013; 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.