1326050402 NPI number — LUIS D POSADAS M.D

Table of content: LUIS D POSADAS M.D (NPI 1326050402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326050402 NPI number — LUIS D POSADAS M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POSADAS
Provider First Name:
LUIS
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326050402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 MEDICAL DR
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23666-1765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-788-0092
Provider Business Mailing Address Fax Number:
757-788-0969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2244 EXECUTIVE DR
Provider Second Line Business Practice Location Address:
SUTIE A
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23666-2430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-315-3650
Provider Business Practice Location Address Fax Number:
757-315-3651
Provider Enumeration Date:
08/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  0101056414 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CO3714 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7118406 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".