Healthcare Provider Details

I. General information

NPI: 1073752051
Provider Name (Legal Business Name): RACHEL M ROMAINE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 J CLYDE MORRIS BLVD
NEWPORT NEWS VA
23601-1927
US

IV. Provider business mailing address

416 J CLYDE MORRIS BLVD
NEWPORT NEWS VA
23601-1927
US

V. Phone/Fax

Practice location:
  • Phone: 757-594-7254
  • Fax:
Mailing address:
  • Phone: 757-594-7254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101247895
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: