1609035377 NPI number — NORA D. JOSE, MD

Table of content: (NPI 1609035377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609035377 NPI number — NORA D. JOSE, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORA D. JOSE, MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1609035377
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2616 SHERWOOD HALL LN
Provider Second Line Business Mailing Address:
STE.404
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22306-3100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-360-0300
Provider Business Mailing Address Fax Number:
703-799-7074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2616 SHERWOOD HALL LN
Provider Second Line Business Practice Location Address:
STE.404
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22306-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-360-0300
Provider Business Practice Location Address Fax Number:
703-799-7074
Provider Enumeration Date:
06/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JOSE
Authorized Official First Name:
NORA
Authorized Official Middle Name:
DOCTOR
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
703-360-0300

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  0101022607 , 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: 080748 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 10231496 . This is a "AMERIGROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 080748 . This is a "ANTHEM HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4996 . This is a "CAREFIRST BLUECROSS BLUESHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 006742173 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4052942 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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