1548212079 NPI number — THERESA E. GUINS M.D.

Table of content: DR. STEPHANIE A RAND MD (NPI 1316331648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548212079 NPI number — THERESA E. GUINS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUINS
Provider First Name:
THERESA
Provider Middle Name:
E.
Provider Name Prefix Text:
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:
1548212079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2021 CONCERT DR STE 102
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:
23456-8082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-668-4933
Provider Business Mailing Address Fax Number:
757-668-4947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3960 VIRGINIA BEACH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23452-2449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-668-4649
Provider Business Practice Location Address Fax Number:
757-668-4644
Provider Enumeration Date:
05/16/2006

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: 208000000X , with the licence number:  0101052583 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0204X , with the licence number: 0101052583 , 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: 0016510250001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006721893 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2002462000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 220531900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7905361 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000015893 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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