MEDICARE: ADDIE ONSANIT 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	207R00000X	Internal Medicine Physician	0101234770	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	466417	OTHER	VA	ANTHEM
2	7711480	OTHER	VA	AETNA
3	71010	OTHER	VA	SENTARA/OPTIMA

General Provider Information

NPI Number	:	1477528016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADDIE ONSANIT MD

Provider Business Mailing Address
First Line	:	PO BOX 7068
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23707-0068
Country	:	US
Telephone Number	:	757-686-3542
Fax Number	:	757-686-0230

Provider Business Practice Location Address
First Line	:	1270 DIAMOND SPRINGS RD
Second Line	:	STE 110
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-3729
Country	:	US
Telephone Number	:	757-464-6944
Fax Number	:	757-464-6952

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	07/08/2007

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