Provider Demographics
NPI:1275830796
Name:TANASESCU-KOGA, AMARIS IRINA (MD)
Entity Type:Individual
Prefix:
First Name:AMARIS
Middle Name:IRINA
Last Name:TANASESCU-KOGA
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 1:263 MCLAWS CIR STE 105
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5674
Mailing Address - Country:US
Mailing Address - Phone:757-941-5600
Mailing Address - Fax:757-564-0557
Practice Address - Street 1:263 MCLAWS CIR STE 105
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185
Practice Address - Country:US
Practice Address - Phone:757-941-5600
Practice Address - Fax:757-564-0557
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301097847207Q00000X
VA0101255606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101255606OtherFAMILY PRACTICE
MI4301097847OtherST LIC