Healthcare Provider Details

I. General information

NPI: 1033145073
Provider Name (Legal Business Name): RAYMOND AMAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 J CLYDE MORRIS BLVD HAMPTON ROADS NEONATOLOGY
NEWPORT NEWS VA
23601-1929
US

IV. Provider business mailing address

307 KANAWAH RUN
YORKTOWN VA
23693-2762
US

V. Phone/Fax

Practice location:
  • Phone: 757-594-2000
  • Fax:
Mailing address:
  • Phone: 757-867-4919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number0101053890
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: