Healthcare Provider Details

I. General information

NPI: 1770584344
Provider Name (Legal Business Name): RICHARD WERTHEIMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL PKWY SUITE 212
CHESAPEAKE VA
23320-4985
US

IV. Provider business mailing address

300 MEDICAL PKWY SUITE 212
CHESAPEAKE VA
23320-4985
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-0508
  • Fax: 757-547-8963
Mailing address:
  • Phone: 757-547-0508
  • Fax: 757-547-8963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberDR.0058777
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: