Provider Demographics
NPI:1902884133
Name:BRUGH, VICTOR M (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:M
Last Name:BRUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:225 CLEARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1815
Mailing Address - Country:US
Mailing Address - Phone:757-457-5100
Mailing Address - Fax:757-961-3934
Practice Address - Street 1:225 CLEARFIELD AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1815
Practice Address - Country:US
Practice Address - Phone:757-457-5100
Practice Address - Fax:757-961-3934
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101056141208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
71246OtherEVMS SENTARA/OPTIMA
VA1902884133OtherANTHEM HEALTHKEEPERS
VA010077371OtherEVMS VA MEDICAID
VA004770E81OtherEVMS VA MEDICARE
VA007504624Medicaid
NC066KMOtherEVMS NC BC/BS
VA465721OtherANTHEM BC BS
NC89066KMOtherEVMS NC MEDICAID
137412OtherEVMS ANTHEM BC/BS
VA65653OtherSENTARA HEALTHCARE
VA1902884133OtherANTHEM HEALTHKEEPERS
H89540Medicare UPIN
VAP00124789Medicare ID - Type UnspecifiedRAILROAD MEDICARE