1225058050 NPI number — DR. ANDREA K MIKSA M.D.

Table of content: DR. ANDREA K MIKSA M.D. (NPI 1225058050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225058050 NPI number — DR. ANDREA K MIKSA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIKSA
Provider First Name:
ANDREA
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1225058050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 BOULDERS PKWY
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23225-5545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-320-4243
Provider Business Mailing Address Fax Number:
804-282-1486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6600 W BROAD ST STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23230-1709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-320-4243
Provider Business Practice Location Address Fax Number:
804-622-0552
Provider Enumeration Date:
07/21/2006

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: 207RP1001X , with the licence number:  0101038764 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0200X , with the licence number: 0101038764 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 006056032 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 31463 . This is a "CARENET PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 759196 . This is a "MAMSI PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 021800 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4800036 . This is a "UNITED HEALTHCARE PROV #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 59293 . This is a "SOUTHER HEALTH PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 188469 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 557515 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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