Provider Demographics
NPI:1144296641
Name:MURILLO, JAIME EDWARDO (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:EDWARDO
Last Name:MURILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:205 BUSINESS PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6535
Mailing Address - Country:US
Mailing Address - Phone:757-962-1083
Mailing Address - Fax:757-962-1254
Practice Address - Street 1:844 KEMPSVILLE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3927
Practice Address - Country:US
Practice Address - Phone:757-261-0700
Practice Address - Fax:757-962-1254
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2009-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101230983207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA389716OtherMAMSI
VA440509OtherATHEM BC/BS VA/HK
VA-001OtherCHAMPUS/TRICARE
PAROtherVIRGINIA HEALTH NETWORK
PAROtherUSA MANAGED CARE
PAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA005856124Medicaid
NC89064EYMedicaid
PAROtherMULTIPLAN
VA15792OtherSENTARA OHP/SHP
VA689716OtherUHC/MAMSI/MDIPA
PAROtherCIGNA
PAROtherAETNA
VA005801559Medicaid
NC064MJOtherBC/BS NC
VA218181OtherANTHEM BC/BS AND HKP
VA38293OtherOPTIMA HEALTH PLAN
NC89064MJMedicaid
PAROtherVIRGINIA PREMIER HEALTH
PAROtherCORVEL/CORCARE
PAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA005856124Medicaid
VA15792OtherSENTARA OHP/SHP
VAH35196Medicare UPIN
VA060001073Medicare PIN