Provider Demographics
NPI:1346120003
Name:WEST, EMMANUEL ANTOIN
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:ANTOIN
Last Name:WEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-1840
Mailing Address - Country:US
Mailing Address - Phone:757-287-1769
Mailing Address - Fax:
Practice Address - Street 1:1613 SPECTATOR ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-3330
Practice Address - Country:US
Practice Address - Phone:804-654-0406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver