1316942964 NPI number — CHRISTINA W PRILLAMAN MD FACP

Table of content: CHRISTINA W PRILLAMAN MD FACP (NPI 1316942964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316942964 NPI number — CHRISTINA W PRILLAMAN MD FACP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRILLAMAN
Provider First Name:
CHRISTINA
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD FACP
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:
1316942964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5900 LAKE WRIGHT DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23502-1871
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-213-5700
Provider Business Mailing Address Fax Number:
757-213-5701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 SENTARA CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23188-5727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-229-2236
Provider Business Practice Location Address Fax Number:
757-221-0409
Provider Enumeration Date:
06/20/2005

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: 207RH0003X , with the licence number:  0101053122 , 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: 830004889 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 005815363 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12542 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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