MARY IMMACULATE HOSPITAL (NPI# 1962719666) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962719666 |
| Entity Type | Organization |
| Organization Name | MARY IMMACULATE HOSPITAL |
| Other Organization Name | VASCULAR SURGERY |
| Practice Address |
2 Bernardine Dr Newport News VA 23602-4404 |
| Practice Telephone | 7578866000 |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2010-09-02 |
| Authorized Official Name | GREG A SIMIA (CFO) |
| Authorized Official Telephone | 7576735928 |
| Is Organization Subpart | Y |
| Parent Organization Name | MARY IMMACULATE HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Vascular Surgery | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629414867 | Mary Immaculate Hospital | Pharmacy | 12720 Mcmanus Blvd Ste 100, Newport News, VA 23602-4414 | 2013-05-15 |
| 1245364223 | Mary Immaculate Hospital | General Acute Care Hospital | 24 Night Heron Dr, Stony Brook, NY 11790-1108 | 2007-03-14 |
| 1316041924 | Mary Immaculate Hospital | Dentist | 11449 Sutphin Blvd, Jamaica, NY 11434-1022 | 2006-09-12 |
| 1194267229 | Mary Immaculate Hospital | Obstetrics & Gynecology | 12720 Mcmanus Blvd, Suite 301, Newport News, VA 23602-4414 | 2016-11-07 |
| 1689047979 | Mary Immaculate Hospital | Surgery | 12720 Mcmanus Blvd, Suite 203, Newport News, VA 23602-4414 | 2015-11-09 |
| 1356625073 | Mary Immaculate Hospital | Internal Medicine | 12720 Mcmanus Blvd, Suite 303, Newport News, VA 23602-4414 | 2011-09-29 |
| 1265715932 | Mary Immaculate Hospital | Obstetrics & Gynecology | 500 Sentara Cir, Suite 102, Williamsburg, VA 23188-5727 | 2011-09-20 |
| 1578841367 | Mary Immaculate Hospital | Internal Medicine | 885 Kempsville Rd, Suite 320, Norfolk, VA 23502-3800 | 2011-07-27 |
| 1003130394 | Mary Immaculate Hospital | Internal Medicine | 12720 Mcmanus Blvd, Suite 201, Newport News, VA 23602-4414 | 2010-03-16 |
| 1164685129 | Mary Immaculate Hospital | Clinic/Center | 14703 Warwick Blvd, Suite A, Newport News, VA 23608-3611 | 2008-07-09 |
| Street Address |
2 BERNARDINE DR |
| City | NEWPORT NEWS |
| State | VA |
| Zip Code | 23602-4404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417955204 | Ruth H. Innes | Family Medicine | 2 Bernardine Dr, Newport News, VA 23602-4404 | 2005-07-14 |
| 1194355214 | Eliezer Dulay Urbano | Clinical Nurse Specialist | 2 Bernardine Dr, Newport News, VA 23602-4404 | 2020-01-16 |
| 1639631849 | Pamela Vancott | Pharmacist | 2 Bernardine Dr, Newport News, VA 23602-4499 | 2019-04-05 |
| 1487116455 | Katherine Nicole Hill Sheppard | Registered Nurse | 2 Bernardine Dr, Newport News, VA 23602-4404 | 2019-04-01 |
| 1053825760 | Anna Marie Rhodes | Specialist/Technologist, Other | 2 Bernardine Dr, Newport News, VA 23602-4404 | 2017-11-17 |
| 1023546256 | Samuel Kyle Holloway | Physician Assistant | 2 Bernardine Dr, Newport News, VA 23602-4404 | 2017-06-01 |
| 1114470853 | Lauren N Sharpe-payne | Speech-Language Pathologist | 2 Bernardine Dr, Newport News, VA 23602 | 2016-07-29 |
| 1538535463 | Mary Immaculate Hospital LLC | General Acute Care Hospital | 2 Bernardine Dr, Newport News, VA 23602-4404 | 2015-08-14 |
| 1518344530 | Jason Bavarian | Emergency Medicine | 2 Bernardine Dr, Newport News, VA 23602-4404 | 2015-04-28 |
| 1760878078 | Catherine Shany Agustiady-becker | Emergency Medicine | 2 Bernardine Dr, Newport News, VA 23602 | 2015-04-13 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538789425 | Aishah Naomi Khursheed | Counselor | 727 J Clyde Blvd, Ste A, Newport News, VA 23602 | 2020-04-21 |
| 1962069526 | Boss Inner Child Counseling, LLC | Clinic/Center | 14203 Old Courthouse Way, Suite B, Newport News, VA 23602 | 2019-05-20 |
| 1922598572 | Manoj Chawla | Internal Medicine | 1000 Old Denbigh Blvd # 1020a, Newport News, VA 23602 | 2018-05-18 |
| 1750896999 | Alexandra Paige Jones | Behavioral Analyst | 12727 Mcmanus Blvd., Newport News, VA 23602 | 2017-12-11 |
| 1457712556 | Mary Ellen Lynch | Registered Nurse | American Addiction Treatment Center, 12695 Mcmanus Blvd, Bdg 2, Newport News, VA 23602 | 2016-03-16 |
| 1790159481 | Megan Ashley Burkart Schmidt | Registered Nurse | 903 Kinsale Cres, Newport News, VA 23602 | 2015-11-18 |
| 1962870733 | Natalie Marie Bradshaw-smith | Nurse Practitioner | 401 Oyster Point Rd Ste A, Newport News, VA 23602 | 2015-09-09 |
| 1477953578 | Jonathan Edwards | Pathology | Bon Secours Mary Immaculate Hospital, Pathology Dept, 2 Bernardine Dr, Newport News, VA 23602 | 2014-08-26 |
| 1588063663 | Cathy G Cooke | Psychologist | 12695 Mcmanus Blvd. Bldg #8, Newport News, VA 23602 | 2014-08-14 |
| 1538576764 | John Michael Sullivan | Psychologist | One Old Oyster Point Road, Newport News, VA 23602 | 2014-07-21 |
| Find all providers in zip 23602 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629586417 | Sentara Medical Group | Surgery | 1051 Loftis Blvd Ste 210, Newport News, VA 23606-3069 | 2018-01-16 |
| 1972980761 | Carlos Jose Torres-medina | Surgery | 500 J Clyde Morris Blvd # 603, Newport News, VA 23601-1929 | 2015-04-30 |
| 1740421049 | Djurabek Babadjanov | Surgery | 500 J Clyde Morris Blvd Ste 603, Newport News, VA 23601-1929 | 2009-03-16 |
| 1821259706 | Jason Lionel Andre | Surgery | 12720 Mcmanus Blvd Ste 303, Newport News, VA 23602-4414 | 2008-06-23 |
| 1992769459 | Joseph John Piotrowski | Surgery | 500 J Clyde Morris Blvd Ste 306, Newport News, VA 23601 | 2006-04-13 |
| 1689047979 | Mary Immaculate Hospital | Surgery | 12720 Mcmanus Blvd, Suite 203, Newport News, VA 23602-4414 | 2015-11-09 |
| 1447679782 | Sathish Mohan | Surgery | 500 J Clyde Morris Blvd Ste 603, Newport News, VA 23601 | 2014-04-15 |
| 1962709048 | Hancock Vein & Surgical Center PC | Surgery | 603 Pilot House Dr, Ste 240, Newport News, VA 23606 | 2011-02-25 |
| 1952613838 | Ernest Francis Zichal | Surgery | 500 J Clyde Morris Blvd, Suite 603, Newport News, VA 23601-1929 | 2010-07-08 |
| 1932426616 | Adam Sagarwala | Surgery | 500 J Clyde Morris Blvd, Newport News, VA 23601-1929 | 2010-04-21 |
| Find all providers in NEWPORT NEWS | ||||
| City | NEWPORT NEWS |
| Zip Code | 23602 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.