Basic Information
| Provider Information | |||||||||
| NPI: | 1477526853 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PLANAS-GALLIANO | ||||||||
| FirstName: | ROQUE | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7068 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237070068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576863516 | ||||||||
| FaxNumber: | 7576860230 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 RIVERVIEW AVE | ||||||||
| Address2: | STE 500 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235101065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572338252 | ||||||||
| FaxNumber: | 7572338905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 12/06/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101029861 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 32995 | 01 | VA | SENTARA/OPTIMA INSURANCE | OTHER | 541951145004 | 01 | VA | TRICARE | OTHER | 284087 | 01 | VA | ANTHEM INSURANCE | OTHER | 5830362 | 05 | VA | MEDICAID | 890552G | 05 | NC | MEDICAID | 541951145 | 01 | VA | CIGNA | OTHER |