Provider Demographics
NPI:1497997712
Name:DISANDRO, GIOVANNI JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GIOVANNI
Middle Name:
Last Name:DISANDRO
Suffix:JR
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 1:885 KEMPSVILLE ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3800
Mailing Address - Country:US
Mailing Address - Phone:757-461-1444
Mailing Address - Fax:757-461-8238
Practice Address - Street 1:885 KEMPSVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3800
Practice Address - Country:US
Practice Address - Phone:757-461-1444
Practice Address - Fax:757-461-8238
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101254154207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA501106OtherANTHEM BC/BS
VAPAROtherAETNA
NC1497997712Medicaid
VAPAROtherUSA MANAGED CARE
VA1497997712OtherVIRGINIA PREMIER HEALTH PLAN
VA1497997712OtherCOVENTRY NETWORK
VAPAROtherCIGNA
VAPAROtherMULTIPLAN
VA10116316OtherOPTIMA HEALTH
VA1497997712Medicaid
VAPAROtherVIRGINIA HEALTH NETWORK
VA-019OtherTRICARE/CHAMPUS
VA1497997712OtherUNITED HEALTHCARE
VAPAROtherCORVEL
VAVVB341AMedicare PIN