Basic Information
| Provider Information | |||||||||
| NPI: | 1619940731 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COQUERAN | ||||||||
| FirstName: | ADRIENNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3241 WESTERN BRANCH BLVD | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233215260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576863508 | ||||||||
| FaxNumber: | 7576860541 | ||||||||
| Practice Location | |||||||||
| Address1: | 7924 CHESAPEAKE BLVD | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235183801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575870157 | ||||||||
| FaxNumber: | 7575870074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2006 | ||||||||
| LastUpdateDate: | 04/09/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 0101033720 | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 541595397 | 01 | VA | TRICARE | OTHER | 541595397 | 01 | VA | AETNA | OTHER | 541595397 | 01 | VA | MID ATLANTIC SOLUTIONS | OTHER | 440814 | 01 | VA | ANTHEM | OTHER | 005613965 | 05 | VA | MEDICAID | 541595397 | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | 41626 | 01 | VA | SENTARA/OPTIMA | OTHER | 541595397 | 01 | VA | CIGNA | OTHER |