Provider Demographics
NPI:1205920246
Name:DESAMOURS, CLAUDINE H (MD)
Entity type:Individual
Prefix:DR
First Name:CLAUDINE
Middle Name:H
Last Name:DESAMOURS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CLAUDINE
Other - Middle Name:H
Other - Last Name:GBAGUIDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10302 BRISTOW CENTER DR
Mailing Address - Street 2:ST 173
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-2201
Mailing Address - Country:US
Mailing Address - Phone:540-454-9944
Mailing Address - Fax:540-680-2143
Practice Address - Street 1:10302 BRISTOW CENTER DR
Practice Address - Street 2:ST 173
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-2201
Practice Address - Country:US
Practice Address - Phone:540-454-9944
Practice Address - Fax:540-680-2143
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236758207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1205920246Medicaid
VA292852OtherAMERIGROUP
VA249158OtherKAISER
VA139180OtherANTHEM
VAK142-0001OtherCARE FIRST 2005
VAP00322422OtherRAILROAD MEDICARE
VA484645OtherNCPPO
VA292852OtherAMERIGROUP
VA007805F81Medicare PIN
VAH97394Medicare UPIN