1437113487 NPI number — MR. VALERIO MARIA GENTA MD

Table of content: STEPHEN C KURACHEK M.D. (NPI 1902807787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437113487 NPI number — MR. VALERIO MARIA GENTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GENTA
Provider First Name:
VALERIO
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MR.
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:
1437113487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2876 GUARDIAN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23452-7327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-463-5240
Provider Business Mailing Address Fax Number:
757-463-6572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1060 FIRST COLONIAL ROAD
Provider Second Line Business Practice Location Address:
SENTARA VIRGINIA BEACH GENERAL HOSPITAL
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23454-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-395-8000
Provider Business Practice Location Address Fax Number:
757-395-8653
Provider Enumeration Date:
04/14/2006

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: 207ZM0300X , with the licence number:  0101033451 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 0101033451 , 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: 6656331 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 780885A . This is a "MEDICAID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 013173 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 270756 . This is a "MPIPA OPTIMA CHOICE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 013173 . This is a "PRIORITY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 35133 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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