1104813765 NPI number — DR. RICHARD A PARISI MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104813765 NPI number — DR. RICHARD A PARISI MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PARISI

Provider First Name:

RICHARD

Provider Middle Name:

A

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1104813765

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/16/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

860 OMNI BLVD STE 101

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

NEWPORT NEWS

Provider Business Mailing Address State Name:

VA

Provider Business Mailing Address Postal Code:

23606-4430

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

757-232-8769

Provider Business Mailing Address Fax Number:

757-232-8875

Provider First Line Business Practice Location Address:

5424 DISCOVERY PARK BLVD

Provider Second Line Business Practice Location Address:

204

Provider Business Practice Location Address City Name:

WILLIAMSBURG

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

23188

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

757-707-3999

Provider Business Practice Location Address Fax Number:

757-707-3993

Provider Enumeration Date:

09/29/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RS0012X , with the licence number:  0101840565 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 23247 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 124025 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 5828538 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 000026211 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 0004643862 . This is a "AETNA-NONHMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 2191626 . This is a "AETNA-HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 208790 . This is a "ANTHEM-GLENSIDE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 48-00265 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 50479 . This is a "CARENET" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 290012067 . This is a "MEDICARE-RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 208789 . This is a "ANTHEM-COLHEIGHTS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 271513 . This is a "MAMSI/ALLIANCE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".