Provider Demographics
NPI:1740405364
Name:KANNARKAT, MILY J (MD)
Entity Type:Individual
Prefix:DR
First Name:MILY
Middle Name:J
Last Name:KANNARKAT
Suffix:
Gender:F
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-7040
Mailing Address - Fax:757-446-7049
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-7040
Practice Address - Fax:757-446-7049
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249801207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1740405364OtherUNITED HEALTHCARE/MAMSI
VAPAROtherAETNA
VA-022OtherTRICARE/CHAMPUS
VA1740405364OtherVIRGINIA PREMIER HEALTH PLAN
VA427872OtherANTHEM BC/BS
NC5917498Medicaid
VA1740405364Medicaid
VAPAROtherCORVEL
VAPAROtherMULTIPLAN
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherCIGNA
VA1740405364OtherFIRST HEALTH NETWORK/SOUTHERN HEALTH/COVENTRY NATIONAL
VAPAROtherUSA MANAGED CARE
VA10077552OtherOPTIMA HEALTH
VAPAROtherAETNA
VA1740405364OtherFIRST HEALTH NETWORK/SOUTHERN HEALTH/COVENTRY NATIONAL