Basic Information
| Provider Information | |||||||||
| NPI: | 1679540553 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RASCONA | ||||||||
| FirstName: | DOMINICK | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235010936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574460374 | ||||||||
| FaxNumber: | 7576242272 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 GRESHAM DR | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235071904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574468920 | ||||||||
| FaxNumber: | 7576242272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 09/16/2010 | ||||||||
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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 | 207R00000X | 0101056691 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 0101056691 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 0101056691 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | PAR | 01 | VA | VA HEALTH NETWORK | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL | OTHER | -029 | 01 | VA | TRICARE/CHAMPUS | OTHER | 966125 | 01 | VI | UHC/MAMSI | OTHER | 450726 | 01 | VA | ANTHEM BC'BS | OTHER | 005834511 | 05 | VA | MEDICAID | 22640 | 01 | VA | SENTARA/OPTIMA | OTHER | 790529Q | 05 | NC | MEDICAID | 0529Q | 01 | NC | BC/BS | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | PAR | 01 | VA | VA PREMIER HEALTH | OTHER | PAR | 01 | VA | CIGNA | OTHER | PAR | 01 | VA | AETNA | OTHER | PAR | 01 | VA | CORVEL/CORCARE | OTHER |