Provider Demographics
NPI:1225058050
Name:MIKSA, ANDREA K (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:K
Last Name:MIKSA
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 1:1000 BOULDERS PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5545
Mailing Address - Country:US
Mailing Address - Phone:804-320-4243
Mailing Address - Fax:804-282-1486
Practice Address - Street 1:6600 W BROAD ST STE 300
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1709
Practice Address - Country:US
Practice Address - Phone:804-320-4243
Practice Address - Fax:804-622-0552
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038764207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006056032Medicaid
VA31463OtherCARENET PROVIDER NUMBER
VA759196OtherMAMSI PROVIDER NUMBER
VA021800OtherCIGNA PROVIDER NUMBER
VA4800036OtherUNITED HEALTHCARE PROV #
VA59293OtherSOUTHER HEALTH PROVIDER #
VA188469OtherANTHEM PROVIDER NUMBER
VA557515OtherAETNA PROVIDER NUMBER
VA557515OtherAETNA PROVIDER NUMBER
VAC75988Medicare UPIN
VA31463OtherCARENET PROVIDER NUMBER
VA290002898Medicare ID - Type UnspecifiedRAILROAD MEDICARE PROV #