Provider Demographics
NPI:1538343223
Name:HAMPTON ROADS CARDIOLOGY, PLLC
Entity type:Organization
Organization Name:HAMPTON ROADS CARDIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:RIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-226-0870
Mailing Address - Street 1:4000 COLISEUM DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5906
Mailing Address - Country:US
Mailing Address - Phone:757-726-0870
Mailing Address - Fax:
Practice Address - Street 1:4000 COLISEUM DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5906
Practice Address - Country:US
Practice Address - Phone:757-726-0870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033473174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101033473OtherLICENSE