Dr. Supakunya Edmonson
Psychiatry & Neurology (Neurology)

Address: Uss Enterprise, Medical Dept, Norfolk, VA 23551-0001
Phone: 7574448632

Dr. Supakunya Edmonson (NPI# 1366420853) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1366420853
Entity Type Individual
Full Name Dr. Supakunya Edmonson
Credential D.O.
Gender Female
Practice Address Uss Enterprise
Medical Dept
Norfolk
VA 23551-0001
Practice Telephone 7574448632
Mailing Address 1714 Pompey St
Virginia Beach
VA 23464-6514
Sole Proprietor No, this individual is not a Sole Proprietor
Enumeration Date 2006-01-04
Last Update Date 2015-05-18

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
No 207Q00000X Family Medicine Allopathic & Osteopathic Physicians OS9620 FL
Yes 2084N0400X Psychiatry & Neurology · Neurology Allopathic & Osteopathic Physicians 0102201767 VA

Other Provider Identifier

State Identifier Issuer Type Code
VA C06778 OTHER GROUP PTAN

Physician Overview

NPI 1366420853
PAC ID by PECOS 2860670262
Professional Enrollment ID I20150817000031
Full Name Supakunya K Edmonson
Organization Legal Name BON SECOURS ST MARYS HOSPITAL OF RICHMOND INC
Phone Number 8048938656
Gender F
Graduation Year 2004
Primary Specialty NEUROLOGY
Group Practice PAC ID 8527969476
Number of Group Practice Members 142
Accepts Medicare Assignment Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
490059 BON SECOURS ST MARYS HOSPITAL
490069 BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER
490032 MEDICAL COLLEGE OF VIRGINIA HOSPITALS
490136 BON SECOURS ST FRANCIS MEDICAL CENTER

Taxonomy Information

Taxonomy Code 2084N0400X
Grouping Allopathic & Osteopathic Physicians
Classification Psychiatry & Neurology
Specialization Neurology

Taxonomy Definition

A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.
Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1811339237 Sahawat Tantikittichaikul Psychiatry & Neurology 301 N 27th St Ste 12, Norfolk, NE 68701 2013-07-26
1689668832 Bruno Michael Maton Psychiatry & Neurology 301 Riverview Ave Ste 202, Norfolk, VA 23510-1065 2005-09-02
1669923298 Sentara Medical Group Psychiatry & Neurology 600 Gresham Dr, Ste 8610, Norfolk, VA 23507-1904 2016-10-19
1558793679 Raymond Gerard Troiano Psychiatry & Neurology 600 Gresham Dr, Suite 8630, Sentara Medical Group Neurology, Norfolk, VA 23507-1904 2013-07-31
1881983278 Bon Secours Depaul Medical Center Inc Psychiatry & Neurology 110 Kingsley Ln, Suite 411, Norfolk, VA 23505-4614 2011-04-06
1588806228 Sara Khorasani Psychiatry & Neurology 2700 W Norfolk Ave, Norfolk, NE 68701-4438 2009-03-26
1336393701 Ingrid Paola Loma-miller Psychiatry & Neurology 6161 Kempsville Cir, Suite 315, Norfolk, VA 23502-3932 2008-11-11
1982865135 Hua Wang Psychiatry & Neurology 600 Gresham Dr, Suite 8630, Norfolk, VA 23507-1904 2008-06-20
1932369980 Steven Thomas Kanarek Psychiatry & Neurology 6161 Kempsville Cir, Suite 315, Norfolk, VA 23502-3932 2008-06-12
1639361033 Carmen Roxana Fuentes Psychiatry & Neurology 6161 Kempsville Cir, Suite 315, Norfolk, VA 23502-3932 2007-08-10
Find all providers in NORFOLK

Office Location

Street Address USS ENTERPRISE
MEDICAL DEPT
City NORFOLK
State VA
Zip Code 23551-0001

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1407820426 Jeffery Wayne Paulson Family Medicine Fleet Forces Command, 1562 Mitscher Ave, Ste 250, Norfolk, VA 23551-0001 2006-02-15
1891775532 Martin Lewis Snyder Surgery U.S.fleet Forces Command-command Surgeon, 1562 Mitscher Ave Suite 250, Norfolk, VA 23551-0001 2006-01-19
1871585448 Tiffany A Jones Dental Hygienist Uss John F. Kennedy Cv-67, 1562 Mitscher Ave Suite 250, Norfolk, VA 23551-0001 2005-08-18
1831724061 Steven Mitchell Hartzler Physician Assistant 1775 Forrestal Dr Bldg 33, Norfolk, VA 23551-0001 2020-03-09
1194205716 Caleb Swain Student in an Organized Health Care Education/Training Program 1775 Forrestal Dr Bldg 33, Norfolk, VA 23551-0001 2018-08-14
1548757263 Dylan Griffiths Student in an Organized Health Care Education/Training Program 1775 Forrestal Dr, Norfolk, VA 23551-0001 2018-04-18
1184129629 Michael Uriah Hoerner Student in an Organized Health Care Education/Training Program Us Marine Corps Forces Command 1775 Forrestal Drive, Norfolk, VA 23551-0001 2018-03-27
1992208763 Philippe Andrew Warren Student in an Organized Health Care Education/Training Program 1775 Forrestal Dr Bldg 33, Norfolk, VA 23551-0001 2018-03-17
1780955534 Christopher Halagarda Dietitian, Registered Us Marine Corps Forces Command, 1775 Forrestal Drive, Norfolk, VA 23551-0001 2012-01-25
1750945333 Scott David Berkheimer Student in an Organized Health Care Education/Training Program 1775 Forrestal Dr Bldg 33, Norfolk, VA 23551-0004 2019-04-29
Find all providers in zip 23551

Competitor

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City NORFOLK
Zip Code 23551

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.