Provider Demographics
NPI:1750394151
Name:KISA, ERIK H (MD)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:H
Last Name:KISA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:109 G GAINSBOROUGH SQUARE
Mailing Address - Street 2:BOX 723
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320
Mailing Address - Country:US
Mailing Address - Phone:757-490-9388
Mailing Address - Fax:757-490-9401
Practice Address - Street 1:736 BATTLEFIELD BLVD N
Practice Address - Street 2:CHESAPEAKE GENERAL HOSPITAL
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4941
Practice Address - Country:US
Practice Address - Phone:757-312-6200
Practice Address - Fax:757-312-6181
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2024-07-26
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Provider Licenses
StateLicense IDTaxonomies
VA0101038744207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
082480OtherBLUE CROSS BLUE SHIELD VA
251490OtherMAMSI/MDIPA
17761OtherOPTIMA
930041251OtherMEDICARE RAILROAD
3900570OtherOPTIMUM CHOICE
0560GOtherBLUE CROSS BLUE SHIELD NC
VA6006591Medicaid
NC890560GMedicaid
VA930041251OtherRR MEDICARE
082480OtherBLUE CROSS BLUE SHIELD VA