| Shallortho | |
|
1232 Perimeter Pkwy Ste 205 Virginia Beach VA 23454-5924 | |
| (757) 762-3582 | |
| Not Available |
| Full Name | Shallortho |
|---|---|
| Speciality | Clinic/Center |
| Location | 1232 Perimeter Pkwy Ste 205, Virginia Beach, Virginia |
| Authorized Official Name and Position | Lawrence Shall (PROVIDER) |
| Authorized Official Contact | 7577623582 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shallortho 4545 Commerce St Unit 2606 Virginia Beach VA 23462-3283 Ph: (757) 762-3582 | Shallortho 1232 Perimeter Pkwy Ste 205 Virginia Beach VA 23454-5924 Ph: (757) 762-3582 |
| NPI Number | 1467050740 |
|---|---|
| Provider Enumeration Date | 10/09/2020 |
| Last Update Date | 10/09/2020 |
| Medicare PECOS PAC ID | 2769802057 |
|---|---|
| Medicare Enrollment ID | O20201027001198 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467050740 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Lawrence M Shall |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1508844366 PECOS PAC ID: 7113932344 Enrollment ID: I20090427000633 |
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