Provider Demographics
NPI:1720196686
Name:NEGREA DUSA, LIVIA SOFIA (MD)
Entity Type:Individual
Prefix:
First Name:LIVIA
Middle Name:SOFIA
Last Name:NEGREA DUSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LIVIA
Other - Middle Name:SOFIA
Other - Last Name:MARICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:68 SOUTH SERVICE ROAD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:516-945-3107
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:500 J CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1929
Practice Address - Country:US
Practice Address - Phone:757-594-2000
Practice Address - Fax:757-826-9028
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26736207L00000X
VA0101246581207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC267366Medicaid
SCAA0493Medicare ID - Type Unspecified
I09311Medicare UPIN