Provider Demographics
NPI:1336193929
Name:HESTER, VICTORIA ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ELLEN
Last Name:HESTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:HESTER
Other - Last Name:MOHANTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:635 N WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-1317
Mailing Address - Country:US
Mailing Address - Phone:804-798-9208
Mailing Address - Fax:804-798-8108
Practice Address - Street 1:635 N WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-1317
Practice Address - Country:US
Practice Address - Phone:804-798-9208
Practice Address - Fax:804-798-8108
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204771207R00000X
VA0101055333207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05704OtherGROUP PTAN
MA9770577Medicaid
MA9770577Medicaid
VAC05704OtherGROUP PTAN