Provider Demographics
NPI:1407019458
Name:KING, JODY P (MD)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:P
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8920
Mailing Address - Fax:757-446-5242
Practice Address - Street 1:825 FAIRFAX AVE STE 445
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8920
Practice Address - Fax:757-446-5242
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249342207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10076474OtherOPTIMA HEALTH
VA-028OtherTRICARE/CHAMPUS
VAPAROtherMULITPLAN
NC5917448Medicaid
VAPAROtherCORVEL
VA427929OtherANTHEM BC/BS
VAPAROtherUSA MANAGED CARE
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherFIRST HEALTH COMMERICAL/COVENTRY HEALTH/SOUTHERN HEALTH
VAPAROtherUNITED HEALTHCARE/MAMSI
VA9964685OtherAETNA
VAPAROtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherCIGNA
VA1407019458Medicaid
VA-028OtherTRICARE/CHAMPUS
VAPAROtherUSA MANAGED CARE