Basic Information
| Provider Information | |||||||||
| NPI: | 1609035377 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORA D. JOSE, MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2616 SHERWOOD HALL LN | ||||||||
| Address2: | STE.404 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223063100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033600300 | ||||||||
| FaxNumber: | 7037997074 | ||||||||
| Practice Location | |||||||||
| Address1: | 2616 SHERWOOD HALL LN | ||||||||
| Address2: | STE.404 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223063100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033600300 | ||||||||
| FaxNumber: | 7037997074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2008 | ||||||||
| LastUpdateDate: | 06/06/2008 | ||||||||
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| AuthorizedOfficialLastName: | JOSE | ||||||||
| AuthorizedOfficialFirstName: | NORA | ||||||||
| AuthorizedOfficialMiddleName: | DOCTOR | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7033600300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | 0101022607 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080748 | 01 | VA | BLUE CROSS BLUE SHIELD | OTHER | 10231496 | 01 | VA | AMERIGROUP | OTHER | 080748 | 01 | VA | ANTHEM HEALTHKEEPERS | OTHER | 4996 | 01 | VA | CAREFIRST BLUECROSS BLUESHIELD | OTHER | 006742173 | 05 | VA | MEDICAID | 4052942 | 01 | VA | AETNA | OTHER |