1972522928 NPI number — DR. NEEMA TILLERY RANDALL D.C.

Table of content: DR. NEEMA TILLERY RANDALL D.C. (NPI 1972522928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972522928 NPI number — DR. NEEMA TILLERY RANDALL D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANDALL
Provider First Name:
NEEMA
Provider Middle Name:
TILLERY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1972522928
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 W WILLIAMSBURG RD STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDSTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23150-1442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-328-0807
Provider Business Mailing Address Fax Number:
804-328-0809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 W WILLIAMSBURG RD STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDSTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23150-1442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-328-0807
Provider Business Practice Location Address Fax Number:
804-328-0809
Provider Enumeration Date:
07/19/2006

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: 111N00000X , with the licence number:  0104556165 , 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: 320200738 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 320200738 . This is a "VA HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 243793 . This is a "SOUTHERN HEALTH SERVICES, INC." identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 320200738 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 320200738 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 495986 . This is a "PHCS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 320200738 . This is a "CHOICE CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2212959 . This is a "FIRST HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 301890 . This is a "BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007828549 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1047502 . This is a "ASHN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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