MEDICARE: DR. DOMINICK A RASCONA 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	0101056691	VA
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	0101056691	VA
3	207RP1001X	Pulmonary Disease Physician	0101056691	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PAR	OTHER	VA	VA HEALTH NETWORK
2	PAR	OTHER	VA	USA MANAGED CARE
3	PAR	OTHER	VA	FIRST HEALTH COMMERCIAL
4	-029	OTHER	VA	TRICARE/CHAMPUS
5	966125	OTHER	VI	UHC/MAMSI
6	450726	OTHER	VA	ANTHEM BC'BS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	22640	OTHER	VA	SENTARA/OPTIMA
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	0529Q	OTHER	NC	BC/BS
11	PAR	OTHER	VA	MULTIPLAN
12	PAR	OTHER	VA	VA PREMIER HEALTH
13	PAR	OTHER	VA	CIGNA
14	PAR	OTHER	VA	AETNA
15	PAR	OTHER	VA	CORVEL/CORCARE

General Provider Information

NPI Number	:	1679540553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINICK A RASCONA MD

Provider Business Mailing Address
First Line	:	PO BOX 936
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23501-0936
Country	:	US
Telephone Number	:	757-446-0374
Fax Number	:	757-624-2272

Provider Business Practice Location Address
First Line	:	600 GRESHAM DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23507-1904
Country	:	US
Telephone Number	:	757-446-8920
Fax Number	:	757-624-2272

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	09/16/2010

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