Basic Information
| Provider Information | |||||||||
| NPI: | 1215173844 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COMANICIU | ||||||||
| FirstName: | ANDRA | ||||||||
| MiddleName: | SILVINA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MIRESCU | ||||||||
| OtherFirstName: | ANDRA | ||||||||
| OtherMiddleName: | SILVINA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 830 KEMPSVILLE RD | ||||||||
| Address2: | FL 1 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235023920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572618070 | ||||||||
| FaxNumber: | 7579957095 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 GRESHAM DR | ||||||||
| Address2: | RALEIGH BLDG, 3RD FLOOR | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573883198 | ||||||||
| FaxNumber: | 7573884242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2009 | ||||||||
| LastUpdateDate: | 10/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 0101252431 | VA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 0101252431 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 036123942 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 036123942 | IL | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 036123942 | 05 | IL | MEDICAID |