Provider Demographics
NPI:1831173665
Name:DAMLE, ANANT S (MD)
Entity type:Individual
Prefix:DR
First Name:ANANT
Middle Name:S
Last Name:DAMLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5818 HARBOUR VIEW BLVD
Mailing Address - Street 2:STE 240
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3315
Mailing Address - Country:US
Mailing Address - Phone:757-483-6100
Mailing Address - Fax:757-483-2203
Practice Address - Street 1:5818 HARBOUR VIEW BLVD
Practice Address - Street 2:STE 240
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3315
Practice Address - Country:US
Practice Address - Phone:757-483-6100
Practice Address - Fax:757-483-2203
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA101221471207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
497934OtherMAMSI OPT CHOICE
VA0010103576Medicaid
005390G25OtherMEDICARE TRAILBLAZERS
20739OtherSENTARA OPTIMA
541870984OtherVA HEALTH NETWORK
C05825OtherMEDICARE GROUP
541870984006OtherCHAMPUS
541870984028OtherCIGNA
NC690627VMedicaid
10103576OtherMEDICAID FIRST HEALTH
P001437930OtherTRAVELERS RR MEDICARE
142987OtherANTHEM HBV
C13214OtherMEDICARE RR GROUP
C13214OtherMEDICARE RR GROUP
541870984OtherVA HEALTH NETWORK