1063474690 NPI number — FRANCESCA LEVINE GLYNN MD

Table of content: FRANCESCA LEVINE GLYNN MD (NPI 1063474690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063474690 NPI number — FRANCESCA LEVINE GLYNN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLYNN
Provider First Name:
FRANCESCA
Provider Middle Name:
LEVINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEVINE
Provider Other First Name:
FRANCESCA
Provider Other Middle Name:
DIANA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063474690
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13700 ST FRANCIS BLVD
Provider Second Line Business Mailing Address:
SUITE 510
Provider Business Mailing Address City Name:
MIDLOTHIAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23114-3222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-423-8470
Provider Business Mailing Address Fax Number:
804-423-8471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13700 ST FRANCIS BLVD
Provider Second Line Business Practice Location Address:
SUITE 510
Provider Business Practice Location Address City Name:
MIDLOTHIAN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23114-3222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-423-8470
Provider Business Practice Location Address Fax Number:
804-423-8471
Provider Enumeration Date:
04/06/2006

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: 207R00000X , with the licence number:  0101051455 , 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: 122919 . This is a "SOUTHERN HEALTH SERVICES" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C06695 . This is a "GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 43927 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4594110 . This is a "AETNA LIFE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4594110 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 228214 . This is a "ANTHEM BCBS OF VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 292495 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0661192 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 110217728 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010017149 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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