Provider Demographics
NPI:1619463270
Name:MARCUM, VIRGINIA ANN (APRN)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ANN
Last Name:MARCUM
Suffix:
Gender:F
Credentials:APRN
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 21890
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4115
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:100 LONDON MOUNTAIN VIEW DR FL 1
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-6668
Practice Address - Country:US
Practice Address - Phone:859-275-5229
Practice Address - Fax:859-977-2683
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
14286219OtherCAQH
6436712OtherCIGNA PROVIDER ID NUMBER
KY7100579870Medicaid
CS1930500243OtherCARESOURCE PROVIDER ID NUMBER
000001302666OtherANTHEM PROVIDER ID NUMBER
KY2017955OtherWELLCARE OF KY PROVIDER ID NUMBER
IN300030020Medicaid
6636596OtherAETNA PROVIDER ID NUMBER
6929516OtherUNITED HEALTHCARE PROVIDER ID NUMBER
KYPDZ000000326570OtherAETNA BETTER HEALTH OF KY PROVIDER ID NUMBER