MEDICARE: DR. JOY DALESANDRO 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	0101233423	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	197596	OTHER		ANTHEM
2	58412	OTHER	VA	OPTIMA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396743332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOY DALESANDRO M.D.

Provider Business Mailing Address
First Line	:	3640 HIGH ST
Second Line	:	SUITE 2D
City	:	PORTSMOUTH
State	:	VA
Zip	:	23707-3213
Country	:	US
Telephone Number	:	757-398-2222
Fax Number	:	757-398-2020

Provider Business Practice Location Address
First Line	:	3640 HIGH ST
Second Line	:	SUITE 2D
City	:	PORTSMOUTH
State	:	VA
Zip	:	23707-3213
Country	:	US
Telephone Number	:	757-398-2222
Fax Number	:	757-398-2020

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	09/29/2009

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