MEDICARE: AMERIGROUP CORPORATION

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1962485540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERIGROUP CORPORATION

Provider Business Mailing Address
First Line	:	4425 CORPORATION LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3103
Country	:	US
Telephone Number	:	757-962-6452
Fax Number	:	757-222-2377

Provider Business Practice Location Address
First Line	:	4425 CORPORATION LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3103
Country	:	US
Telephone Number	:	757-962-6452
Fax Number	:	757-222-2377

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JMAES GORDEN CARLSON
Credential	:
Telephone Number	:	757-962-6452

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	08/22/2020

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