Provider Demographics
NPI:1255325254
Name:PREWITT, KERRY C (MD)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:C
Last Name:PREWITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 CHARLES H DIMMOCK PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2990
Mailing Address - Country:US
Mailing Address - Phone:804-520-1764
Mailing Address - Fax:
Practice Address - Street 1:113 BULIFANTS BLVD STE A
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5719
Practice Address - Country:US
Practice Address - Phone:804-520-1764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057329207RC0000X, 207RI0011X
VA0101041337207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1255325254Medicaid
MD759502600Medicaid
MD759502600Medicaid