Provider Demographics
NPI:1881730083
Name:BOUNDS, KEVIN B (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:B
Last Name:BOUNDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 COLONIAL MEDICAL CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3034
Mailing Address - Country:US
Mailing Address - Phone:757-496-7373
Mailing Address - Fax:757-496-7336
Practice Address - Street 1:1815 COLONIAL MEDICAL CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3034
Practice Address - Country:US
Practice Address - Phone:757-496-7373
Practice Address - Fax:757-496-7336
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043805208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
54-1548377OtherFEDERAL TAX ID
54-1548377OtherFEDERAL TAX ID
VA240000112Medicare PIN