Provider Demographics
NPI:1083817811
Name:CLEARY, ANASTASIA DUMBRA (MD)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:DUMBRA
Last Name:CLEARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1712
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:VA
Mailing Address - Zip Code:22572-1712
Mailing Address - Country:US
Mailing Address - Phone:804-207-3194
Mailing Address - Fax:804-207-3141
Practice Address - Street 1:300 MT CLEMENT PARK
Practice Address - Street 2:STE C
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560-5098
Practice Address - Country:US
Practice Address - Phone:804-443-6063
Practice Address - Fax:804-443-6005
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1083817811Medicaid
VA1083817811Medicaid
VA015463R53Medicare PIN