Healthcare Provider Details

I. General information

NPI: 1194148833
Provider Name (Legal Business Name): RAYMOND MARVIN CLIFTON JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 EDEN WAY N STE 102
CHESAPEAKE VA
23320
US

IV. Provider business mailing address

808 EDEN WAY N STE 102
CHESAPEAKE VA
23320-0745
US

V. Phone/Fax

Practice location:
  • Phone: 757-216-4030
  • Fax: 757-216-4029
Mailing address:
  • Phone: 757-216-4030
  • Fax: 757-216-4029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-04776
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110004380
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: