Basic Information
| Provider Information | |||||||||
| NPI: | 1437113487 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GENTA | ||||||||
| FirstName: | VALERIO | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2876 GUARDIAN LN | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234527327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574635240 | ||||||||
| FaxNumber: | 7574636572 | ||||||||
| Practice Location | |||||||||
| Address1: | 1060 FIRST COLONIAL ROAD | ||||||||
| Address2: | SENTARA VIRGINIA BEACH GENERAL HOSPITAL | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234543002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573958000 | ||||||||
| FaxNumber: | 7573958653 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 03/06/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZM0300X | 0101033451 | VA | N | Allopathic & Osteopathic Physicians | Pathology | Medical Microbiology | 207ZP0102X | 0101033451 | VA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 6656331 | 05 | VA | MEDICAID | 780885A | 01 | NC | MEDICAID | OTHER | 013173 | 01 | VA | ANTHEM | OTHER | 270756 | 01 | VA | MPIPA OPTIMA CHOICE | OTHER | 013173 | 01 | VA | PRIORITY | OTHER | 35133 | 01 | VA | SENTARA | OTHER |