NPIMap

Organization Active NPI

Genesis Aesthetic Face and Vein Specialists, PC

  • Vascular Surgery Physician
  • Suffolk, VA
National Provider Identifier
1770770380
Registry record updated Jul 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
0101040623 Issued in VA
Legal business name
GENESIS AESTHETIC FACE AND VEIN SPECIALISTS, PC
Practice address
1500 Breezeport Way
Suite 100
Suffolk, VA 23435-3727
Phone
(757) 686-9747
NPI assigned
Sep 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2008

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

Authorized official

Name
Dr. Keith Cameron Nichols, MD
Title
President
Phone
(757) 686-9747

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0129X 0101040623 VA Primary

Addresses

Primary practice location

1500 Breezeport Way
Suite 100
Suffolk, VA 23435-3727

Mailing address

1500 Breezeport Way
Suite 100
Suffolk, VA 23435-3727
Phone (757) 686-9747

Other identifiers 1

IdentifierTypeStateIssuer
P00208779OtherVARAILROAD MEDICARE

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1190851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216166400000",
    "number": "1770770380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 BREEZEPORT WAY",
            "address_2": "SUITE 100",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234353727",
            "telephone_number": "757-686-9747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 BREEZEPORT WAY",
            "address_2": "SUITE 100",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234353727",
            "telephone_number": "757-686-9747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS AESTHETIC FACE AND VEIN SPECIALISTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-27",
        "last_updated": "2008-07-16",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "CAMERON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-686-9747",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "VA",
            "license": "0101040623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00208779",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Suffolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2008; 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.