Provider Demographics
NPI:1780824482
Name:MESGHINA, SOLOMIE ASMELASH
Entity Type:Individual
Prefix:
First Name:SOLOMIE
Middle Name:ASMELASH
Last Name:MESGHINA
Suffix:
Gender:F
Credentials:
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 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3520
Mailing Address - Fax:757-686-0230
Practice Address - Street 1:208 E PLUME ST
Practice Address - Street 2:STE 213
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1757
Practice Address - Country:US
Practice Address - Phone:757-233-8210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-002974363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10060907POtherOPTIMA
VA1780824482Medicaid
VA1780824482Medicaid