Healthcare Provider Details

I. General information

NPI: 1265134795
Provider Name (Legal Business Name): VANESSA MARIE RAVE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 VOLVO PKWY STE 100
CHESAPEAKE VA
23320-1621
US

IV. Provider business mailing address

725 VOLVO PKWY STE 100
CHESAPEAKE VA
23320-1621
US

V. Phone/Fax

Practice location:
  • Phone: 757-548-0076
  • Fax:
Mailing address:
  • Phone: 757-548-0076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101289970
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: