Provider Demographics
NPI:1134196611
Name:STOTT, GERALDINE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:ANN
Last Name:STOTT
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:757-446-8999
Mailing Address - Fax:757-446-7922
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 572
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8999
Practice Address - Fax:757-446-7922
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040867207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0665XOtherNC BC/BS
VA006097766Medicaid
257064OtherUHC/MAMSI
VAPAROtherCORVEL/CORCARE
NC890665XMedicaid
VAPAROtherCIGNA
VAPAROtherMULTIPLAN
VAPAROtherFIRST HEALTH COMMERICAL/SOUTHERN HEALTH/COVENTRY
331478OtherANTHEM
54586OtherSENTARA/OPTIMA
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherVIRGINIA HEALTH NETWORK
VA-032OtherTRICARE/CHAMPUS
VAPAROtherAETNA
VAPAROtherUSA MANAGED CARE
NC890665XMedicaid
VAPAROtherCORVEL/CORCARE