Healthcare Provider Details

I. General information

NPI: 1477485548
Provider Name (Legal Business Name): CAS OUTPATIENT DIVISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 CAMBRIDGE DR
RICHMOND VA
23238-3203
US

IV. Provider business mailing address

105 WATCH HARBOUR CT
SUFFOLK VA
23435-3179
US

V. Phone/Fax

Practice location:
  • Phone: 757-276-5022
  • Fax: 757-819-4995
Mailing address:
  • Phone: 757-582-1629
  • Fax: 757-819-4995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTOR PIERRE CLARK
Title or Position: OWNER / CEO
Credential: MD
Phone: 757-582-1629