1396726188 NPI number — DR. MARK GERARD GUARINO DC

Table of content: KELLY DEAN (NPI 1356651764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396726188 NPI number — DR. MARK GERARD GUARINO DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUARINO
Provider First Name:
MARK
Provider Middle Name:
GERARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1396726188
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10148 W BROAD ST
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
GLEN ALLEN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23060-6760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-747-7474
Provider Business Mailing Address Fax Number:
804-965-9360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10148 W BROAD ST
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
GLEN ALLEN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23060-6760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-747-7474
Provider Business Practice Location Address Fax Number:
804-965-9360
Provider Enumeration Date:
11/08/2005

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: 111N00000X , with the licence number:  0104000710 , 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: 170425 . This is a "SOUTHERN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 460541 . This is a "ACN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0827590 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2125679 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4400136 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 054234 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1456026 . This is a "BLUE CROSS HIGH MARK" identifier . This identifiers is of the category "OTHER".