Provider Demographics
NPI:1114068962
Name:SIROT, DEVRA M (MD)
Entity Type:Individual
Prefix:DR
First Name:DEVRA
Middle Name:M
Last Name:SIROT
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 1:9510 GAYTON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5320
Mailing Address - Country:US
Mailing Address - Phone:804-405-2277
Mailing Address - Fax:804-288-7460
Practice Address - Street 1:2038 JOHN ROLFE PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-8111
Practice Address - Country:US
Practice Address - Phone:804-288-7400
Practice Address - Fax:804-288-7460
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230936207Q00000X
LA10131R207Q00000X
CT032514207R00000X
RIMD7707207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA138520OtherBLUE CROSS BLUE SHIELD
VA1464653OtherCIGNA
VA3470405OtherAETNA
VA239445OtherSOUTHERN HEALTH
VA010067979Medicaid
VA010067511OtherVA PREMIER PLAN
VAF37037Medicare UPIN
VA010067979Medicaid