1003850744 NPI number — MARK C DOWNEY MD

Table of content: MARK C DOWNEY MD (NPI 1003850744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003850744 NPI number — MARK C DOWNEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOWNEY
Provider First Name:
MARK
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1003850744
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 BULIFANTS BOULEVARD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-564-7337
Provider Business Mailing Address Fax Number:
757-564-3205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 BULIFANTS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23188-5709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-564-7337
Provider Business Practice Location Address Fax Number:
757-564-3205
Provider Enumeration Date:
06/15/2006

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: 208000000X , with the licence number:  0101231481 , 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: 010126088 . This is a "VA PREMIERE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010126088 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41203 . This is a "SENTARA/OPTIMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12-02789 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-1778786 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-1778786 . This is a "CCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6731745 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-1778786 . This is a "FIRST HEALTH/MAIL HANDLER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7557155 . This is a "AETNA TRADITIONAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-1778786-032 . This is a "CHAMPUS/TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2710497 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-1778786 . This is a "MID ATLANTIC HEALTH SOLUT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 249628 . This is a "SOUTHERN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8128044 . This is a "MAMSI/MDIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 153980 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-1778786 . This is a "VA HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".




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