Healthcare Provider Details

I. General information

NPI: 1275978017
Provider Name (Legal Business Name): REBECCA RYAN SHOEMAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 THIMBLE SHOALS BLVD STE 803
NEWPORT NEWS VA
23606
US

IV. Provider business mailing address

1250 E MARSHALL ST
RICHMOND VA
23298-5051
US

V. Phone/Fax

Practice location:
  • Phone: 757-933-8888
  • Fax: 757-806-6320
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number00116028976
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number0101263940
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: