Provider Demographics
NPI:1548221070
Name:IGNACIO, ELEODORA MERLE (MD)
Entity Type:Individual
Prefix:
First Name:ELEODORA
Middle Name:MERLE
Last Name:IGNACIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S MILITARY HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2251
Mailing Address - Country:US
Mailing Address - Phone:757-424-5778
Mailing Address - Fax:757-523-1966
Practice Address - Street 1:1200 S MILITARY HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2251
Practice Address - Country:US
Practice Address - Phone:757-424-5778
Practice Address - Fax:757-523-1966
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101021365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB09399Medicare UPIN