Provider Demographics
NPI:1669569885
Name:INTERNAL MEDICINE OF PORTSMOUTH LTD
Entity type:Organization
Organization Name:INTERNAL MEDICINE OF PORTSMOUTH LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAUVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-399-7751
Mailing Address - Street 1:3300 HIGH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3321
Mailing Address - Country:US
Mailing Address - Phone:757-399-7751
Mailing Address - Fax:757-393-0743
Practice Address - Street 1:3300 HIGH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3321
Practice Address - Country:US
Practice Address - Phone:757-399-7751
Practice Address - Fax:757-393-0743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAAS07402850001OtherCIGNA
VA46841OtherANTHEM
VA200207OtherOPTIMA/SENTARA
CM8153OtherRAILROAD MEDICARE
CM8153OtherRAILROAD MEDICARE