Provider Demographics
NPI:1164477469
Name:SKENDERIS, BASIL S II (MD)
Entity Type:Individual
Prefix:
First Name:BASIL
Middle Name:S
Last Name:SKENDERIS
Suffix:II
Gender:M
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 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-481-4424
Mailing Address - Fax:757-481-3820
Practice Address - Street 1:1120 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2418
Practice Address - Country:US
Practice Address - Phone:757-481-4424
Practice Address - Fax:757-481-3820
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058373174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
265609OtherMAMSI
394578OtherANTHEM
1700213OtherUNITED HEALTHCARE
213598OtherCIGNA
020042748OtherRAILROAD MEDICARE
NC780531TMedicaid
5511759OtherAETNA
5784160OtherGHI
VA007308736Medicaid
16513OtherOPTIMA HEALTH PLAN
G79278Medicare UPIN
1700213OtherUNITED HEALTHCARE