1164477469 NPI number — BASIL S SKENDERIS II M.D.

Table of content: BASIL S SKENDERIS II M.D. (NPI 1164477469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164477469 NPI number — BASIL S SKENDERIS II M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKENDERIS
Provider First Name:
BASIL
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
M.D.
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:
1164477469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7068
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23707-0068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-481-4424
Provider Business Mailing Address Fax Number:
757-481-3820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 FIRST COLONIAL RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23454-2418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-481-4424
Provider Business Practice Location Address Fax Number:
757-481-3820
Provider Enumeration Date:
05/24/2006

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: 174400000X , with the licence number:  0101058373 , 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: 265609 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 394578 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1700213 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 213598 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 020042748 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 780531T , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5511759 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5784160 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 007308736 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16513 . This is a "OPTIMA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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