Healthcare Provider Details

I. General information

NPI: 1134718703
Provider Name (Legal Business Name): CLAIRE COGSDALE MUELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAIRE MUELLER

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5839 HARBOUR VIEW BLVD STE 200
SUFFOLK VA
23435-3797
US

IV. Provider business mailing address

5839 HARBOUR VIEW BLVD STE 200
SUFFOLK VA
23435-3797
US

V. Phone/Fax

Practice location:
  • Phone: 757-483-6100
  • Fax:
Mailing address:
  • Phone: 757-483-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110007534
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: