Individual
DR. MAIA KOKICHASHVILI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
600 GRESHAM DR FL 5, NORFOLK, VA 23507-1904
(757) 388-3198
(757) 388-4242
Mailing address
600 GRESHAM DR FL 5, NORFOLK, VA 23507-1904
(757) 388-3198
(757) 388-4242
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
NE23395
NE
207R00000X
Internal Medicine Physician
Primary
0101243380
VA
208M00000X
Hospitalist Physician
0101243380
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
247598
MIDLANDS CHOICE PROVIDER
NE
01
—
30375
BC BS IDENTIFICATION NUMB
NE
05
—
NE23395
—
NE
01
—
P00234141
RAILROAD MEDICARE NUMBER
NE
Enumeration date
05/02/2006
Last updated
01/22/2020
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