Basic Information
Provider Information | |||||||||
NPI: | 1386638740 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PRINGLE | ||||||||
FirstName: | TAMARA | ||||||||
MiddleName: | RAUBITSCHEK | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 13700 ST FRANCIS BLVD | ||||||||
Address2: | SUITE 305 | ||||||||
City: | MIDLOTHIAN | ||||||||
State: | VA | ||||||||
PostalCode: | 231143222 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8043202483 | ||||||||
FaxNumber: | 8044191860 | ||||||||
Practice Location | |||||||||
Address1: | 13700 ST FRANCIS BLVD | ||||||||
Address2: | SUITE 305 | ||||||||
City: | MIDLOTHIAN | ||||||||
State: | VA | ||||||||
PostalCode: | 231143222 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8043202483 | ||||||||
FaxNumber: | 8044191860 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/31/2005 | ||||||||
LastUpdateDate: | 06/21/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 0101238415 | VA | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 181293 | 01 |   | ANTHEM | OTHER | 60218 | 01 |   | CARENET | OTHER | 10002838 | 01 |   | SENTARA | OTHER | 1024169 | 01 |   | VA PREMIER | OTHER | 10002838 | 01 |   | OPTIMA HEALTH | OTHER | 1372520 | 01 |   | CIGNA | OTHER | 0000254222203 | 01 |   | UNITED | OTHER | 2137971 | 01 |   | MAMSI | OTHER | 7467784 | 01 |   | AETNA USHEALTH | OTHER | C09633 | 01 | VA | GROUP PTAN | OTHER | 010242169 | 05 | VA |   | MEDICAID | 410214 | 01 |   | SOUTHERN HEALTH | OTHER | 541941044002 | 01 |   | TRICARE | OTHER |