1831152909 NPI number — DR. GARY B BOKINSKY M.D., F.A.C.S.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831152909 NPI number — DR. GARY B BOKINSKY M.D., F.A.C.S.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BOKINSKY

Provider First Name:

GARY

Provider Middle Name:

B

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D., F.A.C.S.

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:

1831152909

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/28/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

9101 STONY POINT DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

RICHMOND

Provider Business Mailing Address State Name:

VA

Provider Business Mailing Address Postal Code:

23235

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

804-330-9105

Provider Business Mailing Address Fax Number:

804-287-6119

Provider First Line Business Practice Location Address:

9101 STONY POINT DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

RICHMOND

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

23235

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

804-330-9105

Provider Business Practice Location Address Fax Number:

804-287-6119

Provider Enumeration Date:

04/10/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208800000X , with the licence number:  0101 023780 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1900006 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 24390 . This is a "ALLIANCE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 4063310 . This is a "AETNA PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 70244 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 2035 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 45719 . This is a "SENTARA FAMILY CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 007504543 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 227426493 . This is a "TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 642076000-00 . This is a "QUALCHOICE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 36466 . This is a "CARENET" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 790396 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".