MEDICARE: DR. DOUGLAS MERCER RAMPONA MD

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	207W00000X	Ophthalmology Physician	0101020148	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10021775	OTHER	VA	OPTIMA
2	261231	OTHER		UNITED HEALTHCARE
3	3395234	OTHER		CIGNA
4	0498931	OTHER		GHI
5	4644028	OTHER		AETNA
6	175159	OTHER	VA	ANTHEM BCBS

General Provider Information

NPI Number	:	1053370007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS MERCER RAMPONA MD

Provider Business Mailing Address
First Line	:	848 FIRST COLONIAL RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6126
Country	:	US
Telephone Number	:	757-428-1005
Fax Number	:

Provider Business Practice Location Address
First Line	:	848 FIRST COLONIAL RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6126
Country	:	US
Telephone Number	:	757-428-1005
Fax Number	:

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	05/25/2012

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