Healthcare Provider Details

I. General information

NPI: 1912521709
Provider Name (Legal Business Name): NAIMAH DEASE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VCUHS DEPT OF EMERGENCY MEDICINE RESIDENCY, 980401 1250 E. MARSHALL STREET
RICHMOND VA
23298-0401
US

IV. Provider business mailing address

363 CEDAR KNOLL CIR # 980257
PINEVILLE NC
28134-6603
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-4860
  • Fax:
Mailing address:
  • Phone: 704-221-2678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number314622
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: