1457571754 NPI number — PEDIATRIC ASSOC OF PETERSBURG

Table of content: JOSEPH CARMINE DANTONIO MD (NPI 1457327538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457571754 NPI number — PEDIATRIC ASSOC OF PETERSBURG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC ASSOC OF PETERSBURG
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1457571754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13213 RIVERS BEND BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23836-8606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-530-7413
Provider Business Mailing Address Fax Number:
804-530-7411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13213 RIVERS BEND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23836-8606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-530-7413
Provider Business Practice Location Address Fax Number:
804-530-7411
Provider Enumeration Date:
04/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALES
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
804-530-7413

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  0101026123 , 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: 2134065 . This is a "OPTIMUM CHOICE DR TAMARA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13767 . This is a "OPTIMA HEALTH MEDICAID HM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 213114 . This is a "OPTIMUM CHOICE DR HERMES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2134065 . This is a "ALLIANCE PPO DR TAMARA CH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4365024 . This is a "AETNA DRPATRICIA GONZALES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6657468 . This is a "CIGNA DR TAMARA CHARITY B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6674705 . This is a "CIGNA DR HERMES DIZON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1243417 . This is a "CIGNA DRPATRICIA GONZALES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 266582 . This is a "SOUTHERN HEALTH DR PATRIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2134065 . This is a "MDIPA DR TAMARA CHARITY B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 23468 . This is a "SENTARA OPTIMA HEALTH DR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1201542 . This is a "UNITED HEALTHCARE DR PATR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 466594 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 13767 . This is a "SENTARA OPTIMA HEALTH DR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 306087 . This is a "SOUTHERN HEALTH DR HERMES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2100405 . This is a "MAMSI DR PATRICIA GONZALE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 213114 . This is a "MDIPA DR HERMES DIZON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5293 . This is a "CARENET DR PATRICIA GONZA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 002478499004 . This is a "UNITED HEALTHCARE DR HERM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 57968 . This is a "CARENET DR TAMARA CHARITY" identifier . This identifiers is of the category "OTHER".




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