Provider Demographics
NPI:1447260823
Name:ARTHUR, AUDREY DELORES (DPM)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:DELORES
Last Name:ARTHUR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 HORACE AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-2704
Mailing Address - Country:US
Mailing Address - Phone:757-499-9646
Mailing Address - Fax:757-671-6373
Practice Address - Street 1:308 HORACE AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2704
Practice Address - Country:US
Practice Address - Phone:757-499-9646
Practice Address - Fax:757-671-6373
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000812213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA93-3226-0Medicaid
VAT51462Medicare UPIN