Provider Demographics
NPI:1174615447
Name:NORFOLK PLASTIC SURGERY, PC
Entity type:Organization
Organization Name:NORFOLK PLASTIC SURGERY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CREECH
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:919-763-0123
Mailing Address - Street 1:6161 KEMPSVILLE CIR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3932
Mailing Address - Country:US
Mailing Address - Phone:757-466-1000
Mailing Address - Fax:757-466-7788
Practice Address - Street 1:6161 KEMPSVILLE CIR
Practice Address - Street 2:SUITE 300
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3932
Practice Address - Country:US
Practice Address - Phone:757-466-1000
Practice Address - Fax:757-466-7788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010561142086S0122X
VA01010449772086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101056114OtherLICENSE
24004907OtherRAILROAD MEDICARE
278499OtherBCBS
VA295242OtherBCBS GROUP
VA006900151Medicaid
E71399OtherUPIN
VA006902090Medicaid
65573OtherOPTIMA
H36682OtherUPIN
024565OtherBCBS
15781OtherOPTIMA
3755OtherASPRS
NC890686CMedicaid
NC890686CMedicaid
BU7390622OtherDEA NUMBER
=========OtherTAX ID
VA00V528L28Medicare ID - Type Unspecified
BU7390622OtherDEA NUMBER
3755OtherASPRS
VA00V528L82Medicare PIN