Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 0101052617 | VA |
Y | 207RP1001X | Pulmonary Disease | 0101052617 | VA |
NPI | 1003832817 |
---|---|
Provider Name | Dr. Michael A Mistretta |
First Address | Richmond, VA 23225-5545 |
Second Address | Richmond, VA 23230-1709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 20/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005812682 | (05) | VA |
021790 | CIGNA PROVIDER NUMBER (01) | VA |
12178 | CARENET PROVIDER NUMBER (01) | VA |
223643 | ANTHEM (01) | VA |
4800040 | UNITED HEALTHCARE PROV # (01) | VA |
557515 | AETNA (01) | VA |
7044153 | MAMSI PROVIDER NUMBER (01) | VA |
80057 | SOUTHER HEALTH PROVIDER # (01) | VA |