Healthcare Provider Details

I. General information

NPI: 1669482758
Provider Name (Legal Business Name): OCCUPATIONAL MEDICINE, EDUCATION AND RESEARCH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 PROFESSIONAL PL #201
CHESAPEAKE VA
23320-3631
US

IV. Provider business mailing address

932 PROFESSIONAL PL #201
CHESAPEAKE VA
23320-3631
US

V. Phone/Fax

Practice location:
  • Phone: 757-481-9406
  • Fax: 757-389-5889
Mailing address:
  • Phone: 757-481-9406
  • Fax: 757-389-5889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number0101037215
License Number StateVA

VIII. Authorized Official

Name: RICHARD CRAVEN
Title or Position: MEMBER/OWNER
Credential: MD
Phone: 757-481-9406