Healthcare Provider Details

I. General information

NPI: 1801268842
Provider Name (Legal Business Name): CAREMORE HEALTH PLAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 BROOK RD
RICHMOND VA
23227-2273
US

IV. Provider business mailing address

5620 BROOK RD
RICHMOND VA
23227-2273
US

V. Phone/Fax

Practice location:
  • Phone: 804-767-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number102203303
License Number StateVA

VIII. Authorized Official

Name: MICHAEL NEIDERER
Title or Position: DO
Credential:
Phone: 804-767-8400