Basic Information
| Provider Information | |||||||||
| NPI: | 1659381697 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALGAVY | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 BUSINESS PARK DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234626335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579621083 | ||||||||
| FaxNumber: | 7579621254 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 KINGSLEY LN | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235054604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578895351 | ||||||||
| FaxNumber: | 7579621254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 10/30/2008 | ||||||||
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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 | 207RC0000X | 0024165422 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 58865N | 01 | VA | OPTIMA HEALTH PLAN | OTHER | 177186 | 01 | VA | ANTHEM MEDIGAP | OTHER |