Healthcare Provider Details

I. General information

NPI: 1346298072
Provider Name (Legal Business Name): DEAN C CAULEY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 A GRANBY ST
NORFOLK VA
23517
US

IV. Provider business mailing address

1909 A GRANBY ST
NORFOLK VA
23517
US

V. Phone/Fax

Practice location:
  • Phone: 757-640-0022
  • Fax: 757-627-8064
Mailing address:
  • Phone: 757-640-0022
  • Fax: 757-627-8064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101228753
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: