1235160813 NPI number — MR. ROBERT LAMIELLE LCP

Table of content: MR. ROBERT LAMIELLE LCP (NPI 1235160813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235160813 NPI number — MR. ROBERT LAMIELLE LCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAMIELLE
Provider First Name:
ROBERT
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCP
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:
1235160813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2202 EXECUTIVE DR (PRIMARY)
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23666-6604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-827-7707
Provider Business Mailing Address Fax Number:
757-838-2573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6330 NEWTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23502-4802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-466-3336
Provider Business Practice Location Address Fax Number:
757-455-5750
Provider Enumeration Date:
07/05/2006

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: 103T00000X , with the licence number:  810002546 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 0810002546 , 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: 010829G34 . This is a "MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 20-4459309 . This is a "CHOICE CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 459414000 . This is a "MAGELLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 20-4459309 . This is a "GREAT WEST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 20-4459309 . This is a "UNITED BH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 236803 . This is a "ANTHEM BC/BC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 328201 . This is a "TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7714734 . This is a "MENTAL HN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7714734 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 214929 . This is a "COM PSYCH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 244656 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 20-4459309 . This is a "AMERICAN PSYCH SYS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 20-4459309 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 20-4459309 . This is a "VIRGINIA HN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 20-4459309 . This is a "BHS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 20-4459309 . This is a "PRIVATE HCS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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