Healthcare Provider Details

I. General information

NPI: 1861781395
Provider Name (Legal Business Name): MATTHEW RAYMOND SUMMERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MATTHEW RAYMOND SUMMERS

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 KEMPSVILLE RD STE 204
NORFOLK VA
23502-3927
US

IV. Provider business mailing address

844 KEMPSVILLE RD STE 204
NORFOLK VA
23502-3927
US

V. Phone/Fax

Practice location:
  • Phone: 757-261-0700
  • Fax: 757-261-0701
Mailing address:
  • Phone: 757-261-0700
  • Fax: 757-261-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101266187
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberRTL
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35.130347
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0101266187
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: