MEDICARE: DR. RAYMOND IGLECIA JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	0101057390	VA
2	207Q00000X	Family Medicine Physician	0101057390	VA

General Provider Information

NPI Number	:	1770786550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND IGLECIA JR. M.D.

Provider Business Mailing Address
First Line	:	3750 CHESTERFIELD AVE
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-2940
Country	:	US
Telephone Number	:	757-460-7189
Fax Number	:

Provider Business Practice Location Address
First Line	:	5792 NORTHAMPTON BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-3726
Country	:	US
Telephone Number	:	757-363-8888
Fax Number	:	757-363-8808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	01/02/2025

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