MEDICARE: MARCIA DENISE CARNEY 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	0101033260	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	178282	OTHER	VA	ANTHEM
2	96354	OTHER	VA	OPTIMA

General Provider Information

NPI Number	:	1669456166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA DENISE CARNEY MD

Provider Business Mailing Address
First Line	:	4433 CORPORATION LN
Second Line	:	SUITE 195
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3351
Country	:	US
Telephone Number	:	757-227-6340
Fax Number	:	757-227-6350

Provider Business Practice Location Address
First Line	:	4433 CORPORATION LN
Second Line	:	CORPORATION IV SUITE 195
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3351
Country	:	US
Telephone Number	:	757-227-6340
Fax Number	:	757-227-6350

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	02/28/2011

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