Basic Information
| Provider Information | |||||||||
| NPI: | 1194781575 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ILIESCU | ||||||||
| FirstName: | ANCA | ||||||||
| MiddleName: | VALERIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 CAMPUS BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406620306 | ||||||||
| FaxNumber: | 5406625845 | ||||||||
| Practice Location | |||||||||
| Address1: | 190 CAMPUS BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406620306 | ||||||||
| FaxNumber: | 5406625845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 0101238812 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 184119 | 01 | ANTHEM PROFESSIONAL | OTHER | 3810004142 | 01 | WV | WELFARE MEDICAID | OTHER | 1769859 | 01 | WV BLUE SHIELD | OTHER | C00085 | 01 | VA MEDICARE B GROUP | OTHER | 10000231 | 01 | SENTARA PROFESSIONAL | OTHER | 2138989 | 01 | MAMSI PROFESSIONAL | OTHER | 008700W85 | 01 | VA MEDICARE B | OTHER |