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NPI Code Detail

MEDICARE: ANN D MINGIONE PHD

MEDICARE: ANN D MINGIONE PHD
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
1103TC0700XClinical Psychologist0810000585VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1176613OTHERVAANTHEM
2087172OTHERVASENTARA

General Provider Information

NPI Number : 1124011622
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANN D MINGIONE PHD
Provider Business Mailing Address
First Line : 3300 ACADEMY AVE
Second Line :
City : PORTSMOUTH
State : VA
Zip : 23703-3205
Country : US
Telephone Number : 757-483-6406
Fax Number : 757-483-0737
Provider Business Practice Location Address
First Line : 3300 ACADEMY AVE
Second Line :
City : PORTSMOUTH
State : VA
Zip : 23703-3205
Country : US
Telephone Number : 757-483-6406
Fax Number : 757-483-0737
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2005
Last Update Date : 07/08/2007

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Directions to “ ANN D MINGIONE PHD” Practice Location

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