1487663407 NPI number — LORETO P VIRTUDES MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487663407 NPI number — LORETO P VIRTUDES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIRTUDES
Provider First Name:
LORETO
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1487663407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3783 FETTLER PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUMFRIES
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22025-1946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-441-1276
Provider Business Mailing Address Fax Number:
703-441-0097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3783 FETTLER PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUMFRIES
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22025-1946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-441-1276
Provider Business Practice Location Address Fax Number:
703-441-0097
Provider Enumeration Date:
08/07/2006

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: 207R00000X , with the licence number:  0101045677 , 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: 210772 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 090227 . This is a "ANTHEM HEALTHKEEPER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1021764 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 474704 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 817893 . This is a "ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1383508 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 607666 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 210772 . This is a "BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: A0660001 . This is a "CAREFIRST BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: A0660001 . This is a "CAREFIRST BLUECHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10719011 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 299294 . This is a "GREATWEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 817893 . This is a "MDIPA" identifier . This identifiers is of the category "OTHER".




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