MEDICARE: BASIL S SKENDERIS II 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	174400000X	Specialist	0101058373	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	020042748	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	265609	OTHER	MAMSI
2	394578	OTHER	ANTHEM
3	1700213	OTHER	UNITED HEALTHCARE
4	213598	OTHER	CIGNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	5511759	OTHER	AETNA
8	5784160	OTHER	GHI
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	16513	OTHER	OPTIMA HEALTH PLAN

General Provider Information

NPI Number	:	1164477469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASIL S SKENDERIS II M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7068
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23707-0068
Country	:	US
Telephone Number	:	757-481-4424
Fax Number	:	757-481-3820

Provider Business Practice Location Address
First Line	:	1120 FIRST COLONIAL RD
Second Line	:	SUITE 203
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2418
Country	:	US
Telephone Number	:	757-481-4424
Fax Number	:	757-481-3820

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	01/10/2017

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Directions to “ BASIL S SKENDERIS II M.D.” Practice Location

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