Provider Demographics
NPI:1679502413
Name:RAMOLIA, MANSUKHLAL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MANSUKHLAL
Middle Name:R
Last Name:RAMOLIA
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 1:4053 TAYLOR RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5537
Mailing Address - Country:US
Mailing Address - Phone:757-638-0085
Mailing Address - Fax:757-686-3025
Practice Address - Street 1:4053 TAYLOR RD
Practice Address - Street 2:SUITE K
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5537
Practice Address - Country:US
Practice Address - Phone:757-483-6401
Practice Address - Fax:757-686-3025
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA073324OtherANTHEM
VA073324OtherANTHEM