Provider Demographics
NPI:1679540553
Name:RASCONA, DOMINICK A (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:A
Last Name:RASCONA
Suffix:
Gender:M
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:757-446-0374
Mailing Address - Fax:757-624-2272
Practice Address - Street 1:600 GRESHAM DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-446-8920
Practice Address - Fax:757-624-2272
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056691207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherVA HEALTH NETWORK
VAPAROtherUSA MANAGED CARE
VAPAROtherFIRST HEALTH COMMERCIAL
VA-029OtherTRICARE/CHAMPUS
VI966125OtherUHC/MAMSI
VA450726OtherANTHEM BC'BS
VA005834511Medicaid
VA22640OtherSENTARA/OPTIMA
NC790529QMedicaid
NC0529QOtherBC/BS
VAPAROtherMULTIPLAN
VAPAROtherVA PREMIER HEALTH
VAPAROtherCIGNA
VAPAROtherAETNA
VAPAROtherCORVEL/CORCARE
VAPAROtherMULTIPLAN
NC0529QOtherBC/BS
VAPAROtherVA HEALTH NETWORK
VA110198559Medicare PIN