Provider Demographics
NPI:1386975183
Name:ZHAO, MINGLU (MSPA)
Entity type:Individual
Prefix:MRS
First Name:MINGLU
Middle Name:
Last Name:ZHAO
Suffix:
Gender:F
Credentials:MSPA
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 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL STREET
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0510
Practice Address - Country:US
Practice Address - Phone:804-628-1171
Practice Address - Fax:804-628-6603
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003563363A00000X
VA0110003385363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109719Medicaid
IL094621OtherHEALTH ALLIANCE
IL10019630OtherBLUECROSS/BLUESHIELD
ILP00166778OtherRAILROAD MEDICARE
IL657869OtherHEATHLINK
IL036109719Medicaid
ILH99697Medicare UPIN