Provider Demographics
NPI:1669446753
Name:MAGNO, ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MAGNO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3241 WESTERN BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5260
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:6632 INDIAN RIVER RD
Practice Address - Street 2:SUITE 103
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3442
Practice Address - Country:US
Practice Address - Phone:757-424-4442
Practice Address - Fax:757-523-4765
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101232935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541595397OtherCIGNA
VA541595397OtherVIRGINIA HEALTH NETWORK
VA7859845OtherAETNA
VA005644518Medicaid
VA541595397OtherTRICARE
VA541595397OtherMID ATLANTIC SOLUTIONS
VA437136OtherANTHEM
VA58233OtherSENTARA/OPTIMA
VA541595397OtherPRIVATE HEALTHCARE SYSTEM
VA437136OtherANTHEM
VAH68544Medicare UPIN