Provider Demographics
NPI:1548375835
Name:SUN, BERYL K G (MD)
Entity type:Individual
Prefix:DR
First Name:BERYL
Middle Name:K G
Last Name:SUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2147 OLD GREENBRIER RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2635
Mailing Address - Country:US
Mailing Address - Phone:757-547-0990
Mailing Address - Fax:757-321-1393
Practice Address - Street 1:2147 OLD GREENBRIER RD
Practice Address - Street 2:SUITE D
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2635
Practice Address - Country:US
Practice Address - Phone:757-547-0990
Practice Address - Fax:757-321-1393
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027205207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA012513OtherANTHEM
VA14031OtherOPTIMA
VA6244149Medicaid
VA211690OtherMDIPA
VA6244149Medicaid