Provider Demographics
NPI:1053362996
Name:VIRGINIA BEACH DEPARTMENT OF PUBLIC HEALTH
Entity type:Organization
Organization Name:VIRGINIA BEACH DEPARTMENT OF PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:A
Authorized Official - Last Name:KULBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:757-518-2630
Mailing Address - Street 1:4452 CORPORATION LN
Mailing Address - Street 2:PEMBROKE CORPORATE CENTER III
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3173
Mailing Address - Country:US
Mailing Address - Phone:757-518-2660
Mailing Address - Fax:757-518-2645
Practice Address - Street 1:4452 CORPORATION LN
Practice Address - Street 2:PEMBROKE CORPORATE CENTER III
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3173
Practice Address - Country:US
Practice Address - Phone:757-518-2660
Practice Address - Fax:757-518-2645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004976185Medicaid
VA600000077Medicare ID - Type UnspecifiedMEDICARE NUMBER