Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 0101035376 | VA |
NPI | 1053396093 |
---|---|
Provider Name | George Marshall Kemp |
First Address | Virginia Beach, VA 23454-2418 |
Second Address | Virginia Beach, VA 23454-2418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 13/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
331101 | BLUECROSSBLUESHIELD (01) | VA |
B09711 | (02) | VA |