Healthcare Provider Details

I. General information

NPI: 1104849132
Provider Name (Legal Business Name): ROGER GUY ALLEN LEVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 GODWIN BLVD FL 1
SUFFOLK VA
23434-8038
US

IV. Provider business mailing address

2800 GODWIN BLVD FL 1
SUFFOLK VA
23434-8038
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-4821
  • Fax: 757-934-4276
Mailing address:
  • Phone: 757-934-4821
  • Fax: 757-934-4276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200401409
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101268989
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101268989
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: