Provider Demographics
NPI:1467428375
Name:QUIDGLEY-NEVARES, ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:QUIDGLEY-NEVARES
Suffix:
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 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:757-446-5915
Mailing Address - Fax:757-446-5969
Practice Address - Street 1:721 FAIRFAX AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-2007
Practice Address - Country:US
Practice Address - Phone:757-446-5915
Practice Address - Fax:757-446-5969
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012318772081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-017OtherTRICARE/CHAMPUS
VA010065801Medicaid
NC06678OtherBC/BS
VA10007083OtherSENTARA/OPTIMA
VA139142OtherANTHEM
VAPAROtherCIGNA
VAPAROtherAETNA
VAPAROtherMULTIPLAN
VAPAROtherUSA MANAGED CARE
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
NC8906678Medicaid
VA76226OtherSENTARA
VAPAROtherCORVEL/CORCARE
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherVIRGINIA HEALTH NETWORK
VA3117723OtherUHC/MAMSI
NC8906678Medicaid
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherCORVEL/CORCARE