Provider Demographics
NPI:1245246669
Name:DILUSTRO, JOSEPH FRANK (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:FRANK
Last Name:DILUSTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 538480
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-8480
Mailing Address - Country:US
Mailing Address - Phone:757-668-7990
Mailing Address - Fax:757-668-7995
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:SUITE 5A
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7990
Practice Address - Fax:757-668-7995
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101043691207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA287396OtherANTHEM BCBS
VA311610834OtherNC HEALTH CHOICE
NC7906416Medicaid
VA298129OtherALLIANCE/MDIPA
VA006101445Medicaid
VA4355191OtherAETNA
VA298129OtherMAMSI/OPTIMUM CHOICE
VA3116108340010EOtherCIGNA
VA50615OtherOPTIMA/SENTARA HEALTH
VA298129OtherALLIANCE/MDIPA
NC7906416Medicaid