Provider Demographics
NPI:1477526853
Name:PLANAS-GALLIANO, ROQUE F (MD)
Entity Type:Individual
Prefix:
First Name:ROQUE
Middle Name:F
Last Name:PLANAS-GALLIANO
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 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3516
Mailing Address - Fax:757-686-0230
Practice Address - Street 1:301 RIVERVIEW AVE
Practice Address - Street 2:STE 500
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-233-8252
Practice Address - Fax:757-233-8905
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029861207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA32995OtherSENTARA/OPTIMA INSURANCE
VA541951145004OtherTRICARE
VA284087OtherANTHEM INSURANCE
VA5830362Medicaid
NC890552GMedicaid
VA541951145OtherCIGNA
VA5830362Medicaid
110007503Medicare PIN