Basic Information
Provider Information | |||||||||
NPI: | 1306051750 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DOBZYNIAK | ||||||||
FirstName: | CHRISTOPHER | ||||||||
MiddleName: | J | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5544 GREENWICH RD STE 200 | ||||||||
Address2: |   | ||||||||
City: | VIRGINIA BEACH | ||||||||
State: | VA | ||||||||
PostalCode: | 234626563 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7574660089 | ||||||||
FaxNumber: | 7574668017 | ||||||||
Practice Location | |||||||||
Address1: | 5544 GREENWICH RD STE 200 | ||||||||
Address2: |   | ||||||||
City: | VIRGINIA BEACH | ||||||||
State: | VA | ||||||||
PostalCode: | 234626563 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7574660089 | ||||||||
FaxNumber: | 7574668017 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/11/2007 | ||||||||
LastUpdateDate: | 02/07/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 4301083691 | MI | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 0101246923 | VA | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 0101246923 | VA | N |   | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
ID | Type | State | Issuer | Description | 10060926 | 01 | VA | SENTARA HEALTH | OTHER | 10076449 | 01 | VA | SENTARA HEALTH | OTHER | 1306051750 | 01 | VA | VA PREMIER HEALTH PLAN | OTHER | 10060926 | 01 | VA | OPTIMA HEALTH | OTHER | 5915198 | 05 | NC |   | MEDICAID | 10076449 | 01 | VA | OPTIMA HEALTH | OTHER | 139178 | 01 | VA | BCBS | OTHER | P00844138 | 01 | VA | RAILROAD MEDICARE | OTHER | 1306051750 | 05 | VA |   | MEDICAID |