MEDICARE: DR. CLAUDINE H DESAMOURS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	0101236758	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00322422	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	292852	OTHER	VA	AMERIGROUP
3	249158	OTHER	VA	KAISER
4	139180	OTHER	VA	ANTHEM
5	K142-0001	OTHER	VA	CARE FIRST 2005
7	484645	OTHER	VA	NCPPO

General Provider Information

NPI Number	:	1205920246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAUDINE H DESAMOURS M.D.

Provider Business Mailing Address
First Line	:	10302 BRISTOW CENTER DR
Second Line	:	ST 173
City	:	BRISTOW
State	:	VA
Zip	:	20136-2201
Country	:	US
Telephone Number	:	540-454-9944
Fax Number	:	540-680-2143

Provider Business Practice Location Address
First Line	:	10302 BRISTOW CENTER DR
Second Line	:	ST 173
City	:	BRISTOW
State	:	VA
Zip	:	20136-2201
Country	:	US
Telephone Number	:	540-454-9944
Fax Number	:	540-680-2143

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	04/15/2015

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