Individual
ANN I MA
Active
Individual
ANN I MA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
00037326
MD
207RG0100X
Gastroenterology Physician
Primary
0101051491
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
203435
ANTHEM BCBS
VA
01
—
247336
UNITED HEALTHCARE MAMSI
—
Enumeration date
09/21/2006
Last updated
10/03/2013
Update your record
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